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Which subspecialties of psychiatry pay the least/most?
- Thread starter XWing5000
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none. the avg salary is barely 200k and likely to go down with psych NPs bringing down costs.
The hell. I thought the average was 250k these days.
Well 2018 Medscape Physician Compensation Report Came Out Today:
Medscape: Medscape Access
FWIW, Psychiatry had #1 increase from 2017 (+16%).
Psych Average salary is now 273K
Closing in on fields like GSurg, OBGYN...
To answer OP, Child Psych is usually the highest. 10-20% pay increase usually.
But apart from that, I don't think you will see much added financial benefit of doing psych fellowship (ie, CL, Addiction). Most academic places might give you extra 10 or 20K if you are fellowship trained, but thats about it.
Its not like medicine or surgery where doing a fellowship can potentially double you salary..
But again, I'm not saying psych fellowships are not useful/worthwhile, just might not be financially as rewarding...
Medscape: Medscape Access
FWIW, Psychiatry had #1 increase from 2017 (+16%).
Psych Average salary is now 273K
Closing in on fields like GSurg, OBGYN...
To answer OP, Child Psych is usually the highest. 10-20% pay increase usually.
But apart from that, I don't think you will see much added financial benefit of doing psych fellowship (ie, CL, Addiction). Most academic places might give you extra 10 or 20K if you are fellowship trained, but thats about it.
Its not like medicine or surgery where doing a fellowship can potentially double you salary..
But again, I'm not saying psych fellowships are not useful/worthwhile, just might not be financially as rewarding...
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Sounds about right. Huge demand right now. But shhhhh, don't tell anyone!
Well, I don't think Child Psychiatrists need to worry anytime soon. I think I read somewhere that the U.S is short of 8 000-10 000 in Child Psychiatrists....
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The average salary is 273k? Wow.
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Most: Pain
Least: Academics (usually)
At least this is true with the discussions ive had with attendings.
Least: Academics (usually)
At least this is true with the discussions ive had with attendings.
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Sleep has gone down the toilet
It's actually probably closer to 300k. Remember, over 70% of psychiatrists work less than 40 hours a week.
So that 273k does not represent a "40 hour week" Psychiatrist.
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Interventional psych pays the most.
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Agreed. It's garbage. All it does is make you a better psychiatrist.
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Stop the chicken little thing about NPs. They are no more threatening to us than primary care efforts to manage psychiatric issues and in many cases not even as good at it.
I have always heard that forensics is the highest paid subspecialty in psych. I'm sure it depends on reputation and how aggressively you market. Forensics and Child are about the only two subspecialties where you really need to do the fellowship to practice it, and I'm not so sure about forensics. I guess sleep and pain are also fellowship musts. CL, addiction, geriatrics, and the numerous other non-accredited fellowships really don't. My 2 cents is that fellowships do help and it is nice to know what you are doing however.
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Seems like CAP and forensics have the most financial upside as the private practice markets can be quite lucrative, at least in my local area.
C/L seems to have the least financial benefit as dedicated C/L positions are generally focused in academic settings/large hospital settings and the work doesn't require fellowship training from the perspective of most employers.
C/L seems to have the least financial benefit as dedicated C/L positions are generally focused in academic settings/large hospital settings and the work doesn't require fellowship training from the perspective of most employers.
Agreed. But isn't it hard to get volume for ECT, rTMS, etc? I'm looking through my list, and I have very, very few "worthy" TRD candidates for interventional psych.
Also, a nurse in my ECT clinic told me that Medicare now covers rTMS...is this true? I thought TMS is still cash only...
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Pretty sure you are replying to a statement made in jest.
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We need to learn how to surgically implant TMS.
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Nah, you have to go for the stuff that gets you repeat customers.
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And why are you assuming you can’t repeat lobotomies?
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I feel like you're just going to get a lot of pushback from insurance and CMS for the repeat procedures here. More trouble than it's worth.
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Is this related to the shift to home sleep studies and fewer true PSG's, or is there other downward pressure on sleep? I still think it's unfortunate more sleep docs didn't make like dentists/optometrists/oncologists and get into the accessory side (CPAP).
Whether in jest or not, there are definitely people in $$ PP around here who are heavily marketing themselves as TMS experts and pushing TMS for pretty much every indication. I'd assume there's some sort of financial incentive, as doing appropriate insurance-paid TMS is a smaller pool of refractory MDD patients.
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Many insurances cover it and I have seen psychiatrists even waive copays for it which is illegal
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It wasn't overnight, it was over like, five years. Interest might begin to wane depending on changes in compensation, but predicting the future of any specialty is like predicting the weather in New England.
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yes- related to both home sleep studies and reduced reimbursement for in-lab studies
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Psych NPs only comprise 3.7% of the NP workforce. It's not exactly a popular area for them to practice in, as it boxes them in far more than generalist NP training, so I'd stop worrying about the sky falling from that angle.
I know, thats why I was seriously asking if medicare does cover rTMS. In NYC, there are psychiatrists charging a lot for 30 sessions over 6 weeks...
Yes, I've been saying this since 2014, but a lot of people said it was "fearmongering" talk, etc.
Is Psych going to become much more competitive in the next few years?
Why is Psych not competitive?
is psych really the new radiology?
Of course, I'm not saying Psych today is Derm or Plastics, but its definitely more competitive than it was 5 years ago.
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I mean, I'm hoping it becomes the next derm or plastics, but I think that is a ways off.
Give it 5 years my friend, lets see what happens.
Mental Health is booming and becoming mainstream everyday.
Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis
This article in nytimes yesterday talking about how mental health plays a major role in maternity/pregnancy/infant morality
Mariah Carey Opens Up About Bipolar Disorder
This also published this week on bipolar....
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I've personally met at least 4 in my two years of residency. 1 who was functioning (very poorly) as the CL person for a community hospital, 1 as a sort-of do-it-all on an academic children's inpatient unit (especially insurance auths in lieu of the attendings), and 2 who were used to extend the (very busy) CL service at a large academic hospital (they mostly saw the easy cases in the ED because there weren't enough residents/attendings to see everything). That doesn't count the many patients I've met with a therapist/psych NP combo in the area. Maybe 30% of consults I see in the ED (who have preexisting mental health care and psych meds) have an NP.
Looks like it. https://www.providerexpress.com/con...s/clinResourcesMain/guidelines/mcs/tmsMCS.pdf
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"Exactly. I've only come across 1 Psych NP so far...."
I have refused MANY job offers because employers required supervision of midlevels as part of the work. Not to mention that they don't decrease your patient load.
I have refused MANY job offers because employers required supervision of midlevels as part of the work. Not to mention that they don't decrease your patient load.
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I’ve met many. I’ve even seen 2 psychiatrists be fired in NM (not desirable area) and replaced with NP’s.
I'm sure anecdotally everyone has met some Psych NPs, but statistically its still very rare.
Demand for Psychiatric Nurse Practitioners
"According to the American Association of Nurse Practitioners (AANPs), there are over 222,000 licensed nurse practitioners in the US as of 2016. Out of this figure, only 2.4 percent have specialized in psychiatric or mental health practice for adults, while three percent handle family-related cases. In total, about 11,988 nurse practitioners currently focus on psychiatric and mental health cases."
Demand for Psychiatric Nurse Practitioners
"According to the American Association of Nurse Practitioners (AANPs), there are over 222,000 licensed nurse practitioners in the US as of 2016. Out of this figure, only 2.4 percent have specialized in psychiatric or mental health practice for adults, while three percent handle family-related cases. In total, about 11,988 nurse practitioners currently focus on psychiatric and mental health cases."
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I'd dispute that "very rare" assertion, given that there are currently only about 25,000 psychiatrists practicing in the US.
I guess we're just "kind of rare", then?
I see your point, but yes, for all intents and purposes, we are "kind of rare" relative to the demand, which has resulted in a mental health crisis.
Psychiatrist Shortage Escalates As U.S. Mental Health Needs Grow
"There are about 28 000 psychiatrists in the U.S, but that number is dwindling rapidly since those practicing are aging. Three in five psychiatrists currently in practice are 55 years of age or older, the AAMC data shows"
Which is pretty low considering there are around 1 million physicians in the U.S...or I guess 2.8% are psychiatrists...
Professionally Active Physicians
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That they make up a small percent of the NP pool isn’t much relevant. They are expanding at a rapid rate. My current state has one residency program and other PMHNP programs in the state are graduating more NPs than the residency program each year. Significantly so.
Fair enough, I definitely don't know much about Psych NP programs, but just based on my personal experience, I have had limited interaction. But I'm sure this varies also geographically..
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The original push by the nursing board was that NP’s would assist in practicing in more rural areas where physicians don’t want to go. This has not turned out to be the case.
With a strong political backing, they are gaining independence. In states like NM, they are fully replacing psychiatrists because of employer costs. NM is starting to see a worsening of psychiatrist shortages because of this. They are moving away to find employment.
In my metropolitan area, insurance based psychiatrists are heavily hiring NP’s instead of psychiatrists. Multiple practices within easy driving distance of me have 1-4 NP’s:1 psychiatrist.
One psychiatrist in my area works inpatient and refers all of his discharges to a clinic staffed by his 3 NP’s.
I actually get many of my patients (cash only) that come from being treated by a NP that has no idea what is going on.
Interesting. Sounds a lot like the CRNA/Anesthesiologist situation....
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Around 40% of the C+A cases I'm seeing inpatient have NP as prescriber, some horrible pharmacology..And at our hospital we have NP covering shifts in the ED, supervised fortunately...the hospital even gives incentive for RN's to complete NP training as long as they work for the health system, I would say it's definitely something to be worried about (dragging down reimbursements for sub-par care)
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Huh, does that potentially fall under a kickback rule?
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"currently about 25,000 psychiatrists practicing in the US" + "about 11,988 nurse practitioners currently focus on psychiatric and mental health cases."
If those numbers are correct it means that every 3 filled mental health positions 1 is occupied by a NP???
What are the odds that you will interact with midlevels??? It seems very high!
As I said, many employed positions nowadays expect you to 'supervise' midlevels- it is part of the job description.
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12,000 NP does not seem very rare when you have 25,000 psychiatrists. Am I right?
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It suggests something close to that. These numbers don't account for the amount of hours or jobs worked by the psychiatrists or NPs. It's very possible that the psychiatrists on average work more, which would make NPs less than 1/3 of the workforce, but I doubt this factor would be enough to make NPs "rare" in mental health. Someone not seeing NPs would be more a function of where they work.
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You're absolutely right, and the numbers are only getting higher. At my hospital multiple RN's are studying for their NP and will be doing psychiatry and mind you this is just the RN they have on staff.
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In my area, the NP’s often work more hours clinically than the psychiatrists that must supervise them.
With the speed of NP’s graduating and new programs being opened, it won’t take long to have more NP’s than psychiatrists.
I recommend psychiatrists to specialize and then either start or join a private practice that will champion the value of psychiatrists. Employed jobs will continue to dissipate in favor of cheaper NP’s.
