Where are you guys finding good job offers?

[brazilianpsych]

So I'm helping a pgy4 in my program to assess jobs. Everything she is getting is around 200-250k, with 4 weeks pto basically. Also got an offer of $1200 as 1099 in a private clinic, seeing around 15 patients a day. Per SDN standards they are all horrible job, but all the offers have been like that. I think she's mostly asking people around, but most academic attendings are not helpful at all. I also took a look at indeed.com but mostly found huge chains that I assume are bad.

Any ideas? Cold calling some private practices or clinics? I'm worried about myself in the future. Seems like the only good gig is your own private practice.

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[Celexa]

So I'm helping a pgy4 in my program to assess jobs. Everything she is getting is around 200-250k, with 4 weeks pto basically. Also got an offer of $1200 as 1099 in a private clinic, seeing around 15 patients a day. Per SDN standards they are all horrible job, but all the offers have been like that. I think she's mostly asking people around, but most academic attendings are not helpful at all. I also took a look at indeed.com but mostly found huge chains that I assume are bad.

Any ideas? Cold calling some private practices or clinics? I'm worried about myself in the future. Seems like the only good gig is your own private practice.

Most good jobs come through networking, not posting, and postings can be out of date. Cold emailing places you might want to work is part of my default advice for residents.

 

[Stagg737]

Part of the problem is you're both fresh meat and employers will take advantage of your lack of knowledge/experience to hire you cheap. In terms of looking for "fair" jobs:

Go to some job fairs, you'll make connections with recruiters who will send waves of listings. Many are pretty bad, but many are also pretty decent.

Cold calling private clinics can work and likely provides better potential earnings than most postings, but also be aware she'll have to work to build her panel and have some business/administrative acumen herself. You can also call hospital recruiters. Large hospitals will have in house recruiters that can discuss opportunities, and some are actually quite reasonable.

Ideally the program would have connections and local or alum practices would reach out with opportunities. We had a couple do that in my residency that our PD forwarded the PGY-3/4 classes about, but this is obviously program dependent.


More importantly, you all need to be able to negotiate. Most jobs are going to try and pay you as little as possible and it's on us (and only us) to call them out and be paid fairly. Residencies do a poor job of preparing us for this, but it's an essential skill. Spend a couple hundred dollars to get access to data from management groups like MGMA or Merritt Hawkins. Being able to take solid data to the table for negotiations to show they're undercutting you is the fastest way to end their arguments about "fair market" rates.

 

[comp1]

$200k is low. $250k is average (most of the country isn't SF or NYC). If you're worried about $250k, you're budgeting wrong. Also how much PTO were you expecting? The absolute gold standard, the federal government, is 26 days vacation, 13 sick.

 

[TexasPhysician]

The best jobs will never advertise positions. Network and call.

 

[annoyedpsychiatrist]

>300k is psych average, i routinely get emails for >300k jobs. 200k is laughable, and 250k would need to have an amazing quality of life. I dont like recruiters but they have their uses sometimes for at least bringing awareness to certain jobs. I liked doccafe and its how i found my current job. The best recruiters are internal ones that are part of the hospital system, in my experience. Other recruiters will try to sell you a terd. Lots of psych jobs, but less quality psych jobs.

Knowning people for sure helps. Agreed on calling hospital recruiters. You could even google the major hospitals systems in the states youre looking and contacting recruiters for those hospital systems

 

[comp1]

Recruiters will seriously mess with salary perspectives. If they are involved, the employer is very desperate and the salary should match. $250k really is the average (based on multiplied hourly salaries since many psychiatrists are not FTE). Psychiatrists

 

[annoyedpsychiatrist]

Recruiters will seriously mess with salary perspectives. If they are involved, the employer is very desperate and the salary should match. $250k really is the average (based on multiplied hourly salaries since many psychiatrists are not FTE). Psychiatrists

Interesting, medscape has psychiatry listed as 310k as the average. Also what they list for my state seems way low, when i previously interviewed for jobs 1.5 year ago even the lowest offer wasnt anywhere near that, and i reached out to many places.

seems really low

 

[comp1]

Medscape is provider reported, a slightly different dataset that has some reporting biases.

 

[Merovinge]

Recruiters will seriously mess with salary perspectives. If they are involved, the employer is very desperate and the salary should match. $250k really is the average (based on multiplied hourly salaries since many psychiatrists are not FTE). Psychiatrists

That would be low for my area and I am not Coastal. Even the private equity run places are paying more for that with 7 clinical hours/day. High 200's to low 300's is a very reasonable expectation for a moderate level of work (busy but enough time to practice good medicine with each patient).

 

[TexasPhysician]

Try to ignore averages. They aren’t worth anything.

$200k for 30 patient contact hours of 1-2/hr and some no-shows with Fridays off isn’t bad in my mind.

$300k for 30 patient contact hours of 3-4 follow-ups per hour +/- no shows and 1 day of weekly call is terrible to me.

$500k for 40 patient hours with 3 follow-ups per hour and 1 weekend per month may be considered wonderful to some and terrible to others.

There isn’t a standard number of contact hours and patients per 40 hour week to compare everything too.

 

[splik]

I've found some good things on LinkedIn (with a lot of detritus to wade through). The thing is you have to negotiate. Don't expect people to offer you up high pay, low patient volumes etc on a platter. They are going to want to pay you as little as they can and get as much work out of you as possible (as a general rule). That's just business.

Also if you're truly getting terrible offers then it is probably worth it to set up your own practice. Even with crappy insurance rates, you should clear over 300 once you get to full time.

 

[Candidate2017]

$200k is low. $250k is average (most of the country isn't SF or NYC).

$250k is below average regardless of whether it's a LCOL or HCOL city.

So I'm helping a pgy4 in my program to assess jobs. Everything she is getting is around 200-250k, with 4 weeks pto basically. Also got an offer of $1200 as 1099 in a private clinic, seeing around 15 patients a day.

$1200 for 15 outpatients is $80 per patient. Since 1099s have to pay for own benefits, malpractice, self employment taxes etc., I'm guestimating you're running $40 per patient.

Seems like the only good gig is your own private practice.

Yes, probably.

But if you want big, quick money, it's hard to beat working 1-3 years for The Man at Big Box shops. Salary + sign on bonus + retention bonus + loan repayment usually means a $1 mil+ deal over 3 years. Just know what you're getting into.

 

[comp1]

People spout numbers off, but aren't really giving sources. I've seen Medscape, which is self report and the DOL which is reported by the employers. And I think averages actually matter a great deal as they at least give you a starting point. It's not an ending point, of course.

 

[annoyedpsychiatrist]

People spout numbers off, but aren't really giving sources. I've seen Medscape, which is self report and the DOL which is reported by the employers. And I think averages actually matter a great deal as they at least give you a starting point. It's not an ending point, of course.

I dunno when I was interviewing for jobs for my first job about 2.5 years ago, i started at >300k. And had 3-4 others offering 280-290. When i started my second attending psych job. When I interviewed for my second job i interviewed at 3 places, and all were >300k with good work/life balance/pto. All were hospital systems though

 

[Stagg737]

$200k is low. $250k is average (most of the country isn't SF or NYC). If you're worried about $250k, you're budgeting wrong. Also how much PTO were you expecting? The absolute gold standard, the federal government, is 26 days vacation, 13 sick.

You're also forgetting that with federal positions you also typically get 5 CME days and 10 (11 with Juneteenth?) federal holidays off per year. So 54 days of PTO annually with up to 80 days of rollover for vacation and unlimited sick time rolling over. At least those were the policies at the 3 VAs I looked into when applying 2 years ago. "Gold standard" doesn't do those PTO benefits justice.

Recruiters will seriously mess with salary perspectives. If they are involved, the employer is very desperate and the salary should match. $250k really is the average (based on multiplied hourly salaries since many psychiatrists are not FTE). Psychiatrists

BLS isn't really a good source for physician salaries. This data does not include self-employed/some private physicians and is also reported based on re-calculated hourly wages. Even for them, they report the average outpatient psychiatrist makes around $275k. From their page:

"(1) Estimates for detailed occupations do not sum to the totals because the totals include occupations not shown separately. Estimates do not include self-employed workers.

(2) Annual wages have been calculated by multiplying the hourly mean wage by a "year-round, full-time" hours figure of 2,080 hours; for those occupations where there is not an hourly wage published, the annual wage has been directly calculated from the reported survey data."

People spout numbers off, but aren't really giving sources. I've seen Medscape, which is self report and the DOL which is reported by the employers. And I think averages actually matter a great deal as they at least give you a starting point. It's not an ending point, of course.

Below is a picture of average physician salary posted in the doctor's lounge of our ~900 bed academic hospital with data from 2021 reporting psychiatrist average salary + bonuses, does not include other benefits or total compensation package:

Spoiler: Average psych pay:

 

[Stagg737]

That would be low for my area and I am not Coastal. Even the private equity run places are paying more for that with 7 clinical hours/day. High 200's to low 300's is a very reasonable expectation for a moderate level of work (busy but enough time to practice good medicine with each patient).

+1 for my experience. I looked throughout the midwest and the only positions where base salary was less than $250k/yr were academic positions or part-time. Everyone else offered at least $250k and almost all of them had production bonuses if they were under $300k. Jobs offering $250k-$300k were very common. OP's experience seems consistent with predatory employers looking to snatch fresh graduates or people needing to keep their Visas.

But again, people on the job hunt need to enter expecting to negotiate. It's rare to "find" a great paying job that's got good balance. You find decent offers and negotiate to make them great.

 

[mistafab]

OP im a pgy4 and got much better offers already. All my leads were from networking or cold contact. I did not really consider “postings” and just reached out directly to staff at places I was interested in. Ive looked both locally and nationally and have not come across such poor offers that you are describing. Are they only looking academic? Or are these part time gigs?

Also, they need to negotiate. Even a DMH job I was offered there are negotiable things (even if salary isnt negotiable). Days worked (3-5/wk), pay for and amount of call, loan forgiveness, relocation, sign on, non compete, pt cap, etc.

 

[brazilianpsych]

Thanks everyone for the replies. Regarding pto, I agree 4 weeks is normal, but I expected/hoped for 300k 4 weeks or 250k 5-6 week, things around that.

I am interested in helping her since next year this will be my problem anyway. I don't know your programs work, but since we only rotate with academic attendings, most of them has no idea where to find different jobs. She's looking everywhere, but I am unsure how good she is at looking around. Don't think she cold called places for example. It's a good idea, I will tell her to do that.

 

[Sushirolls]

I've posted this sort of thing before in the past.

Look where you want to live.

Then make a spreadsheet of everything that smells of psych. Hospitals. state hospitals. Community mental health centers. Private psych groups. VA. Eating disorder clinics? IOP? PHP? Addiction clinics?

Make your list. then note who works there. Does it look like there is a need or room to grow?

Start calling those entities you would be willing to work at for type of work they do/need. Get more information.

Even look to find large therapist groups. Perhaps they want a pscyhiatrist? or perhaps you open your own practice and are embedded in their office?

If you have a visa need, then, well, choose the best of the options that offer a visa.

 

[nexus73]

Linkedin is ok.

Practicelink seems to have a lot of listings as well.

Some states have mandated jobs list salary, so if you search for those states in particular it could give you some insights into what is actually being paid.

I know some major metros pay less than mid size cities, where 200-250K might be the norm in NYC or Seattle for employed jobs. Getting a few hours away from major metros I'd expect getting into 280K-320K range as the norm.

 

[FlowRate]

You'll get better jobs at any of the Kaiser regions than what you posted, so if you're interested in living in CA/OR/WA/CO/GA/VA+MD+DC/HI then you have better options already.

IMO if you're location flexible (or prefer one of those states) and interested primarily in outpatient work then a Kaiser job should be your baseline comparison offer with anything else.

 

[comp1]

Kaiser will WORK you and Kaiser doesn't allow any other employment while you are employed with them. I agree it's a comparison, but when comparing, trust that you will absolutely earn every penny they pay you. And yes, I didn't include the federal holidays because I'm not sure of many outpatient clinics that are open on say Memorial Day or weekends for that matter. I'm sure exceptions exist. Juneteenth is a pretty federal specific benefit that hasn't spread as far.

 

[FlowRate]

Kaiser will WORK you and Kaiser doesn't allow any other employment while you are employed with them. I agree it's a comparison, but when comparing, trust that you will absolutely earn every penny they pay you. And yes, I didn't include the federal holidays because I'm not sure of many outpatient clinics that are open on say Memorial Day or weekends for that matter. I'm sure exceptions exist. Juneteenth is a pretty federal specific benefit that hasn't spread as far.

Refer to prior KP thread for our discussion on how my job is great and not nearly as rough as you describe. YMMV, CA regions probably worst in this regard.

30 patient care hours / 1 hour new 30 min fu / roughly 300k salary + 60-90k in non-salary comp (benefits, retirement, etc.) / 6 weeks vacation / great support staff

Not sure what else you want from an outpatient gig.

 

[Merovinge]

Refer to prior KP thread for our discussion on how my job is great and not nearly as rough as you describe. YMMV, CA regions probably worst in this regard.

30 patient care hours / 1 hour new 30 min fu / roughly 300k salary + 60-90k in non-salary comp (benefits, retirement, etc.) / 6 weeks vacation / great support staff

Not sure what else you want from an outpatient gig.

I would much prefer that world to XYZ's private equity owned we are looking to flip this place in 5 years at 100% growth target setup. Not sure how anyone could feel differently. Now if you know a small group or a single doc that takes cash and wants to bring you on board, that could be superior, but if you want to slot into a place where everything is taken care of, KP seems very legit.

 

[FlowRate]

I would much prefer that world to XYZ's private equity owned we are looking to flip this place in 5 years at 100% growth target setup. Not sure how anyone could feel differently. Now if you know a small group or a single doc that takes cash and wants to bring you on board, that could be superior, but if you want to slot into a place where everything is taken care of, KP seems very legit.

100%, that's basically exactly what I tell people. Permanente Groups are probably the best large employer psychiatry gigs you can easily find without doing a lot of work. There are theoretically better jobs out there that require some combination of: luck, connections, geographic flexibility, timing, search effort, etc.

 

[Psychresy]

I get good jobs by talking to a hundred recruiters, cold calling, etc. Ive got good 1099 jobs I found because I respond to any recruiter who calls. Sometimes there are good jobs out there they have acess to.

 

[MedMan80]

Really depends where you are and the simple laws of supply and demand, 4 years ago i signed a rural undesirable location job for pretty much 340K, this includes sign on/retention bonuses. The work has been CHILL and nice, but boring and i am moving to a larger metro where I'll be started at around 300K (includes retention bonus), this metro was quite saturated and sucked finding a job, i don't think it'll be as chill as my current gig. I had the option of opening my own shop, but obviously worried about ramp up time and how to pay my mortgage without substantial savings.

 

[jbomba]

Maybe I'm just lucky but I've got great jobs which were just posted on the standard job boards or via recruiter calls. Hourly inpatient psych paying 10k a week. A low intensity corrections gig with high pay. Low volume tele ER gig with high pay relative to work load.

 

[untapped]

Are you in the Northeast?

When I was looking 2 years ago, 250-300k was everywhere, and it wasn't too difficult to get offers for 300-350k in the midwest, southeast, and California. I used linkedin, indeed, practicelink, locumtenens. The recruiters can be annoying once they have your number, but it got me lots of practice with job interviews and negotiating. Lots of low ball offers which can be negotiated over 300k or move on to the next job.

I have the 2020 MGMA data - for Gen psych:
Eastern - Mean 255k, Median 251k
Midwest - 323k, Median 308k
Southern - Mean 321k, Median 302k
Western - Mean 315k, Median 316k

 

[finalpsychyear]

Maybe I'm just lucky but I've got great jobs which were just posted on the standard job boards or via recruiter calls. Hourly inpatient psych paying 10k a week. A low intensity corrections gig with high pay. Low volume tele ER gig with high pay relative to work load.

This is pretty standard in california. Don't forget the 1.5-2m house mortgage (ouch at these rates now) for 2500 ish sq feet with little to no yard and highest taxes in the country. So getting 700-800 doing multi gigs is great but probably comparable to 450-500k gigs in midwest adjusted for housing, taxes, gas, and for some the pressure to keep up with high end neighbors to try and fit in.

That being said I will eventually wind up there whether that's renting a place for a few months during the year but only after I have hit some milestones. Now if the person's partner is also making a high salary well kudos you can have your cake (gluten free) and eat it too.

 

[finalpsychyear]

Are you in the Northeast?

When I was looking 2 years ago, 250-300k was everywhere, and it wasn't too difficult to get offers for 300-350k in the midwest, southeast, and California. I used linkedin, indeed, practicelink, locumtenens. The recruiters can be annoying once they have your number, but it got me lots of practice with job interviews and negotiating. Lots of low ball offers which can be negotiated over 300k or move on to the next job.

I have the 2020 MGMA data - for Gen psych:
Eastern - Mean 255k, Median 251k
Midwest - 323k, Median 308k
Southern - Mean 321k, Median 302k
Western - Mean 315k, Median 316k

I remember our residency trying to sell us on staying in house and taking a 170k offer 6-7 years ago. I think a few people took it. I "forgot" to schedule the meeting. I believe the numbers up above are more accurate specifically the median.

 

[psychemdoc]

Maybe I'm just lucky but I've got great jobs which were just posted on the standard job boards or via recruiter calls. Hourly inpatient psych paying 10k a week. A low intensity corrections gig with high pay. Low volume tele ER gig with high pay relative to work load.

How is this possible? Like how do some psychiatrists swear up and down that they can’t find any of these gigs looking in every nook and cranny and having to settle for some okay gig after negotiating harder than Kevin McCarthy and others say they’re just inundated with insanely good offer drops in their face every single day while they’re out buying milk and eggs in the grocery store while wearing a mask, hat, and a trench coat?

The spread in psych is so dramatic to me even in moonlighting in residency. No other specialty has this spread that I’m aware of. I hear some psych res that pays $50 hourly for internal moonlighting and others that pay as high as $230! That’s just not the case for any other specialty that I’m aware of. EM pays high everywhere. Peds pays low everywhere. Etc.

 

[Psychresy]

This is pretty standard in california. Don't forget the 1.5-2m house mortgage (ouch at these rates now) for 2500 ish sq feet with little to no yard and highest taxes in the country. So getting 700-800 doing multi gigs is great but probably comparable to 450-500k gigs in midwest adjusted for housing, taxes, gas, and for some the pressure to keep up with high end neighbors to try and fit in.

That being said I will eventually wind up there whether that's renting a place for a few months during the year but only after I have hit some milestones. Now if the person's partner is also making a high salary well kudos you can have your cake (gluten free) and eat it too.

This is all true. But for comparable pay youre stuck living in the Midwest. As another Californian, this is my take...

My partner is non medical and our total take home this year will be mid to high 800s. Now I'm sure I could live like absolute royalty on this in the Midwest, but I'm still living pretty well out here and saving 15-20k a month between 401k and after tax.

Homes are obviously high, as are taxes, but on this income you can still live a very nice life in CA that is far above even upper middle class.

 

[jbomba]

How is this possible? Like how do some psychiatrists swear up and down that they can’t find any of these gigs looking in every nook and cranny and having to settle for some okay gig after negotiating harder than Kevin McCarthy and others say they’re just inundated with insanely good offer drops in their face every single day while they’re out buying milk and eggs in the grocery store while wearing a mask, hat, and a trench coat?

The spread in psych is so dramatic to me even in moonlighting in residency. No other specialty has this spread that I’m aware of. I hear some psych res that pays $50 hourly for internal moonlighting and others that pay as high as $230! That’s just not the case for any other specialty that I’m aware of. EM pays high everywhere. Peds pays low everywhere. Etc.

Partly it's the fact I live in CA I'm sure. Out here ER, inpatient hourly rates are minimum 230 and usually closer to 250. Overnight rates at two PES near me are paying low 300s an hour. Another lower paying one is 255/hr.

A tele ER gig I have pays 3800 for 24 hour on call from home and I'll see about 7-10 patients. I'll double up and schedule a handful of hours of clinic patients during these home ER shifts. I'll spread them throughout the day so I always have time to jump on and do a consult need be. These days I'll end up generating 5500-6k a day. Repeat 2x a week and I earn 530k a year for two fairly busy days and two overnights a week. Throw in a stretch of corrections coverage once a month, do a few more hours of outpatient or IOP and you're now making 8-850k easily. The key is to double or triple up jobs, take hourly gigs, find jobs which make it easy to double dip (see tele ER or corrections where there's loads of downtime), and be efficient with your time. This is how you make money in psych.

Corrections in particular is very high out here.

Regarding outpatient, reimbursements in multi-provider clinics can be insanely high. I'm starting with a clinic out here at 55% of billings. They sent me their fee schedule and a 99214+90833 generates $330. That's 660 an hour which leaves me with 360 an hour.

Hours wise I'm generally free Thur-fri unless I'm covering corrections or have some clinic hours scheduled. My weekends are generally free unless, again, I'm doing a stretch of corrections.

I hear of co residents who took 40 hour a week inpatient or consult jobs with random overnight call and the odd weekend coverage. They're making high 200s to mid 300s and it just blows my mind. They spend much more hours actually working for less than half the pay. In some cases, much less than half.

I say all this not to brag, so I hope it doesn't come across that way. I just want to give an honest take at how you can go about making "derm" money in psych.

 

[dl2dp2]

Low 200s or below are common in academic or academic-affiliated jobs in large metros. She's probably reporting back to you jobs of that type.

It's very hard to clear 300k in academia even at the division chief level. Only maybe a dozen chairs in the country get paid more than 350k, and often the board/comp committee evaluates that salary based on fundraising goals or other KPIs. Vice chairs max out at 350k even at large departments. This is all public knowledge and you can find that info online at various public salary databases. This is why it's incredibly difficult to retain MD faculty in academia even at large departments. Chairs and hiring committees constantly complain about not being able to hold onto junior faculty, but when you ask them to raise salary they report that there's not enough budget, which is true as most academic psych departments lose money and are propped by clinical needs of other departments.

As per usual, you are right in that the best jobs are jobs that grant you a degree of ownership of the practice.

 

[MedMan80]

I remember our residency trying to sell us on staying in house and taking a 170k offer 6-7 years ago. I think a few people took it. I "forgot" to schedule the meeting. I believe the numbers up above are more accurate specifically the median.

"how silly and absent minded of me to miss such a meeting"

 

[MedMan80]

Low 200s or below are common in academic or academic-affiliated jobs in large metros. She's probably reporting back to you jobs of that type.

It's very hard to clear 300k in academia even at the division chief level. Only maybe a dozen chairs in the country get paid more than 350k, and often the board/comp committee evaluates that salary based on fundraising goals or other KPIs. Vice chairs max out at 350k even at large departments. This is all public knowledge and you can find that info online at various public salary databases. This is why it's incredibly difficult to retain MD faculty in academia even at large departments. Chairs and hiring committees constantly complain about not being able to hold onto junior faculty, but when you ask them to raise salary they report that there's not enough budget, which is true as most academic psych departments lose money and are propped by clinical needs of other departments.

As per usual, you are right in that the best jobs are jobs that grant you a degree of ownership of the practice.

I'll add that some state academic places have nice benefits (apart from PSLF eligibility and residents carrying much of the heavy lifting), this obviously varies from place to place. They often have harder to treat populations to contend with as well.

 

[soundnin]

Corrections in particular is very high out here.

Tried to PM you but couldn't. Would you mind sharing the details on some of the offers you see for corrections work in CA?

 

[Candidate2017]

The spread in psych is so dramatic to me even in moonlighting in residency. No other specialty has this spread that I’m aware of. I hear some psych res that pays $50 hourly for internal moonlighting and others that pay as high as $230! That’s just not the case for any other specialty that I’m aware of.

The pay spread is wide for residents because... residents.

For attendings, the wide pay spread is because... ignorance. Psychiatrists are the most ignorant physicians I've ever met regarding billing codes, RVUs, insurance reimbursement, and all things related to pay including negotiating. Psychiatrists seem unable to talk candidly with colleagues about pay. This is ironic given our job requires us to ask patients about very personal matters. For reference, I know at least 2 colleagues who get 40% less than me despite being more experienced, child, etc.

 

[comp1]

Corrections jobs aren't hard to find. There's many reasons they pay so well and are so plentiful (even compared to psychiatry in general, which is plentiful). Here for CA: Psychiatry Careers Definitely concur that we need to talk more about salaries openly and candidly. All federal employees and most state employees have their salaries publicly posted, but also...most of those jobs don't have negotiable salaries as they are set by their respective governmental agencies for the position, not the person.

 

[Merovinge]

The pay spread is wide for residents because... residents.

For attendings, the wide pay spread is because... ignorance. Psychiatrists are the most ignorant physicians I've ever met regarding billing codes, RVUs, insurance reimbursement, and all things related to pay including negotiating. Psychiatrists seem unable to talk candidly with colleagues about pay. This is ironic given our job requires us to ask patients about very personal matters. For reference, I know at least 2 colleagues who get 40% less than me despite being more experienced, child, etc.

I think it's almost taboo in our field (that was previously one of the absolute lowest paying specialties) to talk about money, as if it is a badge of honor to make less or see ourselves as in the same struggle as our patients. Frankly in some ways we are the tax base that pays to keep the country running while the actually wealthy take loans on stock they will never repay and stepup in basis when they pass. However, someone making 300k is still facing a dramatically different experience than many of the patients we treat and I think that makes some psychiatrists feel uncomfortable. I know, because I straddle the line of feeling insanely well of but also working class at the same time; I grew up from very modest means and feel like I do relate but also keep in mind how patient's people see me.

We are seeing this changing in front of our eyes on SDN with more talk about salary and finance, but even then people get squeamish if you start talking about VTSAX, accumulating wealth, FI, etc.

 

[finalpsychyear]

Partly it's the fact I live in CA I'm sure. Out here ER, inpatient hourly rates are minimum 230 and usually closer to 250. Overnight rates at two PES near me are paying low 300s an hour. Another lower paying one is 255/hr.

A tele ER gig I have pays 3800 for 24 hour on call from home and I'll see about 7-10 patients. I'll double up and schedule a handful of hours of clinic patients during these home ER shifts. I'll spread them throughout the day so I always have time to jump on and do a consult need be. These days I'll end up generating 5500-6k a day. Repeat 2x a week and I earn 530k a year for two fairly busy days and two overnights a week. Throw in a stretch of corrections coverage once a month, do a few more hours of outpatient or IOP and you're now making 8-850k easily. The key is to double or triple up jobs, take hourly gigs, find jobs which make it easy to double dip (see tele ER or corrections where there's loads of downtime), and be efficient with your time. This is how you make money in psych.

Corrections in particular is very high out here.

Regarding outpatient, reimbursements in multi-provider clinics can be insanely high. I'm starting with a clinic out here at 55% of billings. They sent me their fee schedule and a 99214+90833 generates $330. That's 660 an hour which leaves me with 360 an hour.

Hours wise I'm generally free Thur-fri unless I'm covering corrections or have some clinic hours scheduled. My weekends are generally free unless, again, I'm doing a stretch of corrections.

I hear of co residents who took 40 hour a week inpatient or consult jobs with random overnight call and the odd weekend coverage. They're making high 200s to mid 300s and it just blows my mind. They spend much more hours actually working for less than half the pay. In some cases, much less than half.

I say all this not to brag, so I hope it doesn't come across that way. I just want to give an honest take at how you can go about making "derm" money in psych.

Glad to hear things are going well. I predict you will transition your overnights and wknds to eventually all business hours. I refused to work nights, wknds, holidays ever again after residency so i built my whole schedule based on that and with the ability to do "work cations" so essentially i can be remote and still work if needed. Also, taking admin roles helps cement your positions for the long haul so its harder to replace you i.e. med director etc and obviously the PP.

 

[SmallBird]

I recently switched to a federal job in California (which, in relation to my other thread, has been a positive shift more my sense of meaning in my work), and have been mostly happy with the benefits. The pay is a hair over $300k, and then there was a sign on bonus which I can request annually as a retention bonus. So maybe $315k all told. But a major benefit is that there is both a 5% on 401k contributions and a pension system, which is valued at around $900k for every 10 years you work. The bureaucracy is unfathomable but my response is to let it set the pace and not worry about it, which has worked well. I am more comfortable with this salary given that I spent 4 years grinding out RVUs so have a firm base of savings.