Why is Psych not competitive?

[Shikima]

The beatings will continue until morale improves.

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[Bartelby]

well this is completely different from anything about what causes happiness. if your program is teaching you about happiness and its causes, it would be the exception that proves the rule.

I guess we may be talking about different things? What do you mean by happiness? Like positive psychology (mihaly csikszentmihalyi for instance)? We do get introduced to those ideas, and it is easy to pursue further reading on your own.

 

[splik]

happiness studies is its own field encompassing economics, sociology, psychology, public policy that is quite separate if not unrelated to positive psychology. i would be very surprised though intrigued if these were things were being taught in any residency program (and don't really think they should). psychiatry doesn't really have anything to tell us about happiness though some of the economic literature on happiness (such as richard layard's work) does look at depression.

 

[whopper]

the chief of staff at my VA is a psychiatrist.

I've seen a trend where psychiatrists tend to go up the administrative ladder. Why? I don't know if any studies have pointed anything but I think it's because our field tends to have interacting with people and not being technicians so much (e.g. surgery, doing procedures). In psychiatry, you have more room to develop other pursuits because the hours don't have to be terrible.

happiness studies is its own field encompassing economics, sociology, psychology, public policy that is quite separate if not unrelated to positive psychology. i would be very surprised though intrigued if these were things were being taught in any residency program (and don't really think they should). psychiatry doesn't really have anything to tell us about happiness though some of the economic literature on happiness (such as richard layard's work) does look at depression.

Psychology and psychiatry are related but separate fields. We don't, for example, learn behavioral economics anywhere near to the degree that psychologist learns it. Our expertise from that area, if anything, comes from simply seeing several people act in differential ways to various rewards and punishments over time, and then come to understand what they may do or not do in the future. (E.g. patient never follows up with depot antipsychotic shots).

 

[Frazier]

Maybe you have the wrong idea of where I would've heard of such a thing as I've made my way from biology undergrad to medical school and then to being tossed overboard into the world of mental illness, scrambling to keep my head above water.

You say 4 horsemen and I'm looking for The Apocalypse.

I am of course interested in picking up general psychology along the way aside from the C- I got in it in 1992. Of which I remember not one f'n thing.

We're physicians first remember. That thing takes you 8 years to get.

And not all of us grew up snortling along with the intellectual escapades of Frazier. Or majored in psychology dying to be that psychy psych guy with the subdued intellectual style.

I used to think this was a bad thing and that I was somehow deficient for not knowing general psych stuff. I don't anymore. The people with these backgrounds are no better than the rest of us at doing the job. And I'd rather assemble my own custom academic framework around the clinical questions I face.

Hey, baby, I hear the blues a callin'....

 

[Bmewriter]

Psychology and psychiatry are related but separate fields. We don't, for example, learn behavioral economics anywhere near to the degree that psychologist learns it. Our expertise from that area, if anything, comes from simply seeing several people act in differential ways to various rewards and punishments over time, and then come to understand what they may do or not do in the future. (E.g. patient never follows up with depot antipsychotic shots).

Still powerful <3

At times, I feel though the fields should be linked far more closely. There are a lot of things going on in psychology that can be of benefit to psychiatry as well.

 

[hamstergang]

As far as I'm aware, there is good amount of backing for both 4 horsemen and microexpressions as signals of emotions (not so much as tools for lie detection)

If I'm reading your thread in the Psychology forum correctly, this isn't quite right. They seem to be suggesting that microexpressions are a real thing if you look at a person on tape frame by frame, but not so much in real time. Am I mistaken?

 

[clausewitz2]

If I'm reading your thread in the Psychology forum correctly, this isn't quite right. They seem to be suggesting that microexpressions are a real thing if you look at a person on tape frame by frame, but not so much in real time. Am I mistaken?

This is a reasonable summary of the actual literature on the subject in which Ekman does not appear as a co-author.

 

[nitemagi]

For happiness/positive psych, look to Seligman.

 

[thepoopologist]

This keeps making me confused. This is the field in which you have low hours and yet a lot of pay.

My own 2 cents is it is the result of
The medical student population
The stark difference between it and other specialties in medical school
Generally not being taught well in medical school
Prestige

 

[Dharma]

This keeps making me confused. This is the field in which you have low hours and yet a lot of pay.

Shhh...

 

[Thewonderer]

Psychiatrists don't make a lot of money. ROAD = Radiology, Orthopedic (or ophthalmology), Anesthesiology and Dermatology really do make a lot more money. I would no be surprised if they all make $1+ million per year. It is very hard to make $500k+ as a psychiatrist. It is simple. Time does not pay in medicine. Derm sees a patient for 5 minutes, do a small procedure and get paid $250+. And the pt is satisfied and will not come back to bother the dermatologist.

Psych is not prestigious.

 

[punkedoutriffs]

Psychiatrists don't make a lot of money. ROAD = Radiology, Orthopedic (or ophthalmology), Anesthesiology and Dermatology really do make a lot more money. I would no be surprised if they all make $1+ million per year. It is very hard to make $500k+ as a psychiatrist. It is simple. Time does not pay in medicine. Derm sees a patient for 5 minutes, do a small procedure and get paid $250+. And the pt is satisfied and will not come back to bother the dermatologist.

Psych is not prestigious.

 

[Frazier]

Psychiatrists don't make a lot of money. ROAD = Radiology, Orthopedic (or ophthalmology), Anesthesiology and Dermatology really do make a lot more money. I would not be surprised if they all make $1+ million per year. It is very hard to make $500k+ as a psychiatrist. It is simple. Time does not pay in medicine. Derm sees a patient for 5 minutes, do a small procedure and get paid $250+. And the pt is satisfied and will not come back to bother the dermatologist.

Psych is not prestigious.

This degree of salary hyperbole would make even vistaril blush.

 

[heyjack70]

Psychiatrists don't make a lot of money. ROAD = Radiology, Orthopedic (or ophthalmology), Anesthesiology and Dermatology really do make a lot more money. I would no be surprised if they all make $1+ million per year. It is very hard to make $500k+ as a psychiatrist. It is simple. Time does not pay in medicine. Derm sees a patient for 5 minutes, do a small procedure and get paid $250+. And the pt is satisfied and will not come back to bother the dermatologist.

Psych is not prestigious.

Agreed, you have to work your ass off to make $500K in psych

 

[clausewitz2]

If you go over to the optho forum, it is not hard to find people getting offers by private practice groups just out of residency in the neighborhood of 120K. There is a reason they all seem to do hyper-specific fellowships these days. Hint:it is not because there are piles of money for generalists.

 

[smalltownpsych]

Psychiatrists don't make a lot of money. ROAD = Radiology, Orthopedic (or ophthalmology), Anesthesiology and Dermatology really do make a lot more money. I would no be surprised if they all make $1+ million per year. It is very hard to make $500k+ as a psychiatrist. It is simple. Time does not pay in medicine. Derm sees a patient for 5 minutes, do a small procedure and get paid $250+. And the pt is satisfied and will not come back to bother the dermatologist.

Psych is not prestigious.

One million dollars! Muwahahaha! You know, one million just isn't as impressive as it once was Dr. Evil, maybe those derm guys shoul ask for a BILLION dollars! Muwahahaha!

 

[MacDonaldTriad]

Dr. Evil: Gentlemen, I have a plan. It's called blackmail. The Royal Family of Britain are the wealthiest landowners in the world. Either the Royal Family pays us an exorbitant amount of money, or we make it seen that Prince Charles has had an affair outside of marriage and therefore would have to divorce!
Number Two: Prince Charles *did* have an affair. He admitted it, and they are now divorced.
Dr. Evil: Right, people you have to tell me these things, okay? I've been frozen for thirty years, okay? Throw me a frickin' bone here! I'm the boss! Need the info.
[pause]
Dr. Evil: Okay no problem. Here's my second plan. Back in the 60's, I had a weather changing machine that was, in essence, a sophisticated heat beam which we called a "laser." Using these "lasers," we punch a hole in the protective layer around the Earth, which we scientists call the "Ozone Layer." Slowly but surely, ultraviolet rays would pour in, increasing the risk of skin cancer. That is unless the world pays us a hefty ransom.
Number Two: [pause] That also already has happened.
[in original pressings, Number Two said "That also has already been done."]
Dr. Evil: ****. Oh hell, let's just do what we always do. Hijack some nuclear weapons and hold the world hostage. Yeah? Good! Gentlemen, it has come to my attention that a breakaway Russian Republic called Kreplachistan will be transferring a nuclear warhead to the United Nations in a few days. Here's the plan. We get the warhead and we hold the world ransom for... ONE MILLION DOLLARS!

 

[Thewonderer]

I don't know why people would laugh at a doctor making $1 million per year. I don't know why people would think a dermatologist/radiologist/orthopedic/anesthesiologist cannot make $1 million per year.

I have been in private practice for a while now and I can see how much people actually make.

The salary survey out there is crap. For example, the salary survey says that psychiatrist on average makes $150,000 a year? That is obviously too low. If you work decent hard and there is some competition out there, you can probably make between $250,000 to $300,000 with a couple potential employers competing for your service. Then beyond $300k a year, you have to work really hard and it is hard for me to conceive a psychiatrist making $500k a year. Time just does not pay in medicine. You spend 45 minutes doing psychotherapy and insurance gives you $170.

However, procedure is what pays in medicine. And if the salary survey says that ortho is making $400k to $500k, I can guarantee you that is under-reported. Some who work hard can rack in $1+ million.

There is a reason why ortho hates clinics because they don't make a lot of money on post-op visits. Psych might be jealous and say, what is wrong with ortho seeing a patient for 5-10 minutes and make a post-op note about the wound healing, and get paid $100? Well for an ortho, that is like nothing. $100 x 5 patients an hour is only $500 an hour. They can make a lot more money per hour on surgeries and on steroid shots. Ask your patient who recently got steroid shots by ortho or outpatient pain doc (who is inevitably a gas guy) for his/her latest EOB's. Take a look.

Again, if you have any wives/babies and during delivery, your wife got epidural, then read the letter of explanation of benefits (EOB) when it arrives in the mail and see how much the anesthesiologist charged for that epidural and GOT PAID by the insurance company. You will see I am not exaggerating that many anesthesiologists make $1+ million per year.

There is a movement now where the hospital and the surgeon or ob-gyn are in-network while the WHOLE anesthesiology department are out of network. So you don't have a choice. You go in, and then the anesthesiologists bill like crazy and then stick you with the bill because they are out of network and balance bill you for whatever amount. They sent your bill to some stupid 1-800 number "collection agency" on the opposite coast and those billers just harass you with the same set of sentences, "your bill is now overdue and it is subject to sent to collection." I know because I had to deal with them. I told them, I am a doctor. I know my CPT codes. The bill is over-inflated. I can point this out to be "over-aggressive" billing or more frankly "insurance fraud." Either way, you have to come down on it. These 1-800 number people don't care because they have no brain and they are hired just to keep on sticking you with the bill. After 2-months of going nowhere, then I wrote them a letter to threaten to report the anesthesiologist to the medical board. Finally the anesthesiologist called me up personally to settle the bill at a more reasonable amount. I paid him $1000 for 15-min of his time at bedside and that is a discount of the original bill of $4200. No joke.

I am done talking.

 

[Frazier]

I don't know why people would laugh at a doctor making $1 million per year. I don't know why people would think a dermatologist/radiologist/orthopedic/anesthesiologist cannot make $1 million per year.

The idea was getting teased because the above is not what you said.

This is what you said:

Psychiatrists don't make a lot of money. ROAD = Radiology, Orthopedic (or ophthalmology), Anesthesiology and Dermatology really do make a lot more money. I would not be surprised if they all make $1+ million per year.

They are very different claims.

Saying all folks in "Radiology, Orthopedic (or ophthalmology), Anesthesiology and Dermatology" make over 1M per year is absolutely ridiculous.

You will see I am not exaggerating that many anesthesiologists make $1+ million per year.

MGMA has the 50th percentile in Gas at ~470k...the 90th percentile just under 600k.
Saying it is very common for the average anesthesiologist (along with the others you listed) to pull in >1M per year is patently false regardless of what you have encountered in your community. Statistics, with a much wider net than yours, simply say otherwise.

That said, sounds like we will agree on the distribution regarding psych vs those other fields. Clearly more common in the latter than the former. Not to be confused with saying it is common (for any specialty) in general.

 

[Nasrudin]

I agree frazsh but is anyone else shocked at the statistics you made. That's a ton of cash. I never really thought about money except to rule out peds for its potential to take me 2 lifetimes to pay off my loans, so some of this stuff still surprises me.

I think the Wonderer's point stands in the sense that we have to talk to people for 45 minutes and offer excellence and/or unscrupulousness to make several notches above crappy pay compared to these specialties.

It's definitely one of the reasons we remain less popular with med students.

Which brings me to a question:

What do you think factors into our relative high job flexibility and demand? It doesn't seem to me that that sort of thing would be altered by med student popularity. And given the poor fee/service ratio in psych...what do we think about the potential persistence of flexibility and demand?

It seems like insurance companies are scrambling to figure out how to not pay for psych services.

 

[Frazier]

I agree frazsh but is anyone else shocked at the statistics you made. That's a ton of cash. I never really thought about money except to rule out peds for its potential to take me 2 lifetimes to pay off my loans, so some this stuff still surprises me.

Def big dollar signs.

I think the Wonderer's point stands in the sense that we have to talk to people for 45 minutes and offer excellence and/or unscrupulousness to make several notches above crappy pay compared to these specialties.

It's definitely one of the reasons we remain less popular with med students.

I can get behind this statement.
Certainly paid less comparatively than most.
However, despite big baseline at ~470k... claiming >1M for all is...well, still over 100% off the mark.

Which brings me to a question:

What do you think factors into our relative high job flexibility and demand? It doesn't seem to me that that sort of thing would be altered by med student popularity. And given the poor fee/service ratio in psych...what do we think about the potential persistence of flexibility and demand?

It seems like insurance companies are scrambling to figure out how to not pay for psych services.

I think the job flexibility is largely tied to the nature of the work. If we are talking hours, other than maybe something like CL(?), psych's off hour presence in the hospital approaches what the RadOnc's told me (tongue in cheek) about their treatment philosophy: "Cancer doesn't grow on nights or weekends."

Demand as you know is tied to supply, if 10k new psych graduates were produced overnight, demand and employed salaries would plummet down.

Regarding the last bit, persistence of flexibility, I don't predict it change much given no foreseeable shifts in the way the specialty is practiced. Regarding persistence of demand, I don't see that changing much either anytime soon -- esp with the huge geri population rolling out over the next 25 years. Most IM/FP/Peds physicians I've encountered followed this ideal: "A crappy psychiatrist isn't worth a plugged nickel, a good psychiatrist is worth their weight in gold."

I hope to be in the latter category and keep my demand (referrals) high.

Interested in hearing others' thoughts...

Enough 1 AM rambling from me, time to recharge the batteries.

 

[Thewonderer]

When I said, they all make $1+ million, I mean there are many people in ALL of those specialties who make $1+ million. No, I did not mean every single radiologist makes $1 million. Please read my post more carefully. I listed the specialties. I did not list radiologists/anesthesiologists/dermatologists/orthopedists and they all make $1 million a year.

You can believe in the salary survey all you want. I don't believe in the survey.

You all can agree that most psychiatrists make more than $150k a year but yet the survey suggests the average psychiatrist makes $150k-$180k. Even a psychiatrist who starts at a county clinic makes $180k straight out of residencies. In the other thread people are debating how VA's are now hiring psychiatrist starting at $180k to $210k. How about people who are mid-career and have been in private practice for several years? How much more do they make? In another thread, a moonlighter getting paid at $110 per hour and people are giving him a hard time, saying he should ask for a pay raise to $160 per hour. Ok do any of these real world numbers suggest an "average" psychiatrist pay of $150k-$180k, accounting for people who just start out v.s. people who have been in the real world for 10+ years or 20+ years? How the heck the average of all these people end up being $150k to $180k in the survey? I tried to recruit another psychiatrist who graduated from the same residency program, two years behind me to work for me. She is working for a system in Arizona. She is getting paid $230k per year plus benefits including 401(k). Well, that just ruined my recruiting effort because Arizona is not that of an expensive place to live at.

So the answer is, simple, the survey is under-reported and is way off.

Now extrapolate that to the salary survey of orthopedics and dermatologists, etc.

There is a reason why psychiatrists are considered under-paid. People on this thread are throwing around all the numbers of how well psychiatrists are doing on a per-hour basis. Seriously, you are delusional if you think psychiatrist are paid well per hour compared to orthopods and gas guys EVEN if the psychiatrists charge $500 per hour like some do in Manhattan.

There is a reason that psychiatry is not a popular field, simply based on income.

I rest my case.

 

[Thewonderer]

However, despite big baseline at ~470k... claiming >1M for all is...well, still over 100% off the mark.

Let us go back to psychiatry math here. Survey says 50% is $150k or 180k.

Real world number on this board alone says, starting salary at the County and at the VA is $180k to $210k. Kaiser, as a system, is offering $200k plus signing bonus starting out. This is consistent with my attempt to recruit another psychiatrist who is only 3 years out and is making $230k already, in a system place, with benefits and 401(k) plan. This is starting salary.

It is not inconceivable for someone in private practice who is gaining steam and is now 5 years out, and is now making $330k a year from combination of moonlighting (which from another thread pays probably in the $140-$150 per hour range) and their own private practice.

$330k is more than double $150k in the stupid survey and almost double $180k in another survey.

Can the survey under-report by a large margin? Heck yeah.

 

[Nasrudin]

To make good money?!

Let's just say you're making a good point. The fact the we suck relatively but that it's more than the reported average.....That's great news man. So the gas men are making a million. Good for them. If it means better likelihood of us doing better too.

 

[Leo Aquarius]

I don't know why people would laugh at a doctor making $1 million per year. I don't know why people would think a dermatologist/radiologist/orthopedic/anesthesiologist cannot make $1 million per year.

I have been in private practice for a while now and I can see how much people actually make.

The salary survey out there is crap. For example, the salary survey says that psychiatrist on average makes $150,000 a year? That is obviously too low. If you work decent hard and there is some competition out there, you can probably make between $250,000 to $300,000 with a couple potential employers competing for your service. Then beyond $300k a year, you have to work really hard and it is hard for me to conceive a psychiatrist making $500k a year. Time just does not pay in medicine. You spend 45 minutes doing psychotherapy and insurance gives you $170.

However, procedure is what pays in medicine. And if the salary survey says that ortho is making $400k to $500k, I can guarantee you that is under-reported. Some who work hard can rack in $1+ million.

There is a reason why ortho hates clinics because they don't make a lot of money on post-op visits. Psych might be jealous and say, what is wrong with ortho seeing a patient for 5-10 minutes and make a post-op note about the wound healing, and get paid $100? Well for an ortho, that is like nothing. $100 x 5 patients an hour is only $500 an hour. They can make a lot more money per hour on surgeries and on steroid shots. Ask your patient who recently got steroid shots by ortho or outpatient pain doc (who is inevitably a gas guy) for his/her latest EOB's. Take a look.

Again, if you have any wives/babies and during delivery, your wife got epidural, then read the letter of explanation of benefits (EOB) when it arrives in the mail and see how much the anesthesiologist charged for that epidural and GOT PAID by the insurance company. You will see I am not exaggerating that many anesthesiologists make $1+ million per year.

There is a movement now where the hospital and the surgeon or ob-gyn are in-network while the WHOLE anesthesiology department are out of network. So you don't have a choice. You go in, and then the anesthesiologists bill like crazy and then stick you with the bill because they are out of network and balance bill you for whatever amount. They sent your bill to some stupid 1-800 number "collection agency" on the opposite coast and those billers just harass you with the same set of sentences, "your bill is now overdue and it is subject to sent to collection." I know because I had to deal with them. I told them, I am a doctor. I know my CPT codes. The bill is over-inflated. I can point this out to be "over-aggressive" billing or more frankly "insurance fraud." Either way, you have to come down on it. These 1-800 number people don't care because they have no brain and they are hired just to keep on sticking you with the bill. After 2-months of going nowhere, then I wrote them a letter to threaten to report the anesthesiologist to the medical board. Finally the anesthesiologist called me up personally to settle the bill at a more reasonable amount. I paid him $1000 for 15-min of his time at bedside and that is a discount of the original bill of $4200. No joke.

I am done talking.

I've figured it out.

Thewonderer came first, and for whatever reason started a second avatar named Vistaril.

Must be the same person. They share in the same anti-psychiatric hyperbolic language with a keen focus on salary, money, cash, mullah.

 

[Leo Aquarius]

When I said, they all make $1+ million, I mean there are many people in ALL of those specialties who make $1+ million. No, I did not mean every single radiologist makes $1 million. Please read my post more carefully. I listed the specialties. I did not list radiologists/anesthesiologists/dermatologists/orthopedists and they all make $1 million a year.

You can believe in the salary survey all you want. I don't believe in the survey.

You all can agree that most psychiatrists make more than $150k a year but yet the survey suggests the average psychiatrist makes $150k-$180k. Even a psychiatrist who starts at a county clinic makes $180k straight out of residencies. In the other thread people are debating how VA's are now hiring psychiatrist starting at $180k to $210k. How about people who are mid-career and have been in private practice for several years? How much more do they make? In another thread, a moonlighter getting paid at $110 per hour and people are giving him a hard time, saying he should ask for a pay raise to $160 per hour. Ok do any of these real world numbers suggest an "average" psychiatrist pay of $150k-$180k, accounting for people who just start out v.s. people who have been in the real world for 10+ years or 20+ years? How the heck the average of all these people end up being $150k to $180k in the survey? I tried to recruit another psychiatrist who graduated from the same residency program, two years behind me to work for me. She is working for a system in Arizona. She is getting paid $230k per year plus benefits including 401(k). Well, that just ruined my recruiting effort because Arizona is not that of an expensive place to live at.

So the answer is, simple, the survey is under-reported and is way off.

Now extrapolate that to the salary survey of orthopedics and dermatologists, etc.

There is a reason why psychiatrists are considered under-paid. People on this thread are throwing around all the numbers of how well psychiatrists are doing on a per-hour basis. Seriously, you are delusional if you think psychiatrist are paid well per hour compared to orthopods and gas guys EVEN if the psychiatrists charge $500 per hour like some do in Manhattan.

There is a reason that psychiatry is not a popular field, simply based on income.

I rest my case.

Idiot. Psychiatrists from San Fran to Palo Alto, from north LA down to San Diego charge $350 per hour and up. How do I know? Because I live here and they tell me. My attending makes $400K from his PP.

Thewonderer, come back and talk to us with REAL facts. Facts from psychiatrists. Until then, don't bother yapping.

 

[Thewonderer]

I really find it fascinating that I can get on people's nerves so much. You are giving me too much credit.

 

[smalltownpsych]

I really find it fascinating that I can get on people's nerves so much. You are giving me too much credit.

It's not that fascinating. Just make a ridiculous unfounded claim that other specialties make 1million per year and you will annoy people. I highly doubt that money has anything to do with the popularity of the specialty. Here is a more likely speculation. I am thinking most kids who want to go to med school to be a doctor think about taking care of sick people. You know, broken bones, measles, rare diseases, cutting out tumors. Real doctor stuff. Probably not too many go in with the idea of working with mental illness and when they do, half the time they become a psychologist or social worker instead. What is really a mystery is how people end up being pathologists.

 

[675015]

Anesthesia making a million a year? Maybe a pain fellow who completely sells out in his treatment practices. Your typical anesthesiologist definitely does not make a million a year.

 

[Bmewriter]

Anyway, Psych isn't that interesting to me because of the money. It's because of how powerful it actually can be if you know what you are doing. =D

And it seems like a lot of the patient population that needs help isn't getting the help they need cuz too many other students/doctors find the patients emotionally draining. =/

 

[scudiera]

Okay Bmewriter I think you're a little (or a lot) misinformed about what Psychiatry does, it's not mind-reading, it's not telepathy, it's not magic tricks...or whatever. But okay you're enthusiastic, that's good I guess.

As for medical students? Yeah, part of it is honestly the money. I considered other fields because the salary surveys were super disappointing. And it's okay to feel that way. Then I realized 220-250k is more reasonable in early practice than the awful 130-170k I was seeing and that's working like 40-45 hours a week, and that's pretty awesome because I value my personal life a lot and grew up on a lot less than that kind of money and had a good childhood. I've seen what a lot of money can do for people, both good and bad, and reminded myself that if I start chasing the paper now it'll only get worse later on in my life. But the other part is that unless you're at a great medical school with a strong psych program you're going to see some very boring stuff taught to you by pretty old, slow people, and you may not have the awesome Med-Psych or C/L experience that lets students know that yes, Psychiatrists know their medicine and haven't just forgotten everything.

But thewonderer, you're worse than vistaril, seriously. Ortho can make over 1 million, yes - they're also doing f***ing surgery! You know, person, cut open, broken bones, blood everywhere, could die! Stop comparing procedural fields to non-procedural. And by the way, as you've been corrected before, unless you're working crazy hours in gas you're not seeing 1 million these days outside of pain. Most gas docs will tell you Anesthesia is not a lifestyle field anymore. And the pain guys sell themselves out to make big money and I'm speaking from a fair amount of experience here. Derm is procedure and economics - they've kept the number of derm seats low while other fields have seen bigger increases in the number of resident spots, which maintains a high demand. If you want to make fair comparisons look at Psych vs non-procedural medicine fields that manage chronic illness, like endocrine, nephrology, hepatology (not GI), pulm (non-sleep), etc. It's on par. Except the Psychiatrist saves 2 years of training and has better hours.

 

[Bmewriter]

Okay Bmewriter I think you're a little (or a lot) misinformed about what Psychiatry does, it's not mind-reading, it's not telepathy, it's not magic tricks...or whatever. But okay you're enthusiastic, that's good I guess.

I think I said somewhere in this thread I was exaggerating. But microexpressions and the 4 horsemen are a thing. =P

And besides, to learn about what makes people feel a certain way and to treat the disorders of the mind (or soul) that are associated with that is power.

 

[675015]

I think I said somewhere in this thread I was exaggerating. But microexpressions and the 4 horsemen are a thing. =P

And besides, to learn about what makes people feel a certain way and to treat the disorders of the mind (or soul) that are associated with that is power.

But how are the four horsemen thing going to uniquely help you in your psychiatry practice?

 

[Bmewriter]

But how are the four horsemen thing going to uniquely help you in your psychiatry practice?

May or may not depending on the disorder or issues that I would want treated. If there is a lot of contempt in a relationship, then that might clue me in on something that I need to ask more about.

After all, the data does seem to be out that the 4 horsemen predict divorce pretty well. Still, it's not something that I would use to make any clinical recommendations. I think that should come more from the entire history of the patient and figuring out what works well for a specific patient vs what doesn't.

 

[Frazier]

Requesting some sort of brief, summarizing reading material on what exactly these microexpressions/4 horseman are about...

 

[Bmewriter]

Requesting some sort of brief, summarizing reading material on what exactly these microexpressions/4 horseman are about...

Supposedly, Paul Ekman discovered a way to see a person's emotion on the face called microexpressions, named because they are expressions that last for a fraction of a second, that reveal the true thoughts and feelings about how someone is feeling. There are seven universal ones: Happiness, Sadness, Fear, Anger, Surprise, Disgust and Contempt. He has a book out called "Emotions Revealed". However, it seems like other papers have questioned their reliability and I think that a lot of people don't use them to make any final calls. There is a reddit thread here going against them and it cites some papers:

http://www.reddit.com/r/askscience/comments/1en9bc/is_there_any_solid_scientific_evidence_that/

The four horsemen of the apocalypse are the predictors of divorce that were devised by John Gottman, who was a professor of psychology. Supposedly, these things occur in an argument between two people and predict which marriages will either divorce or end up unhappy. They are: Criticism, Contempt, Defensiveness or Stonewalling. From what I heard, he's able to predict whether a couple will divorce >90% of the time. He has several books out, one of which is "The Seven Principles of Making Marriage Work."

These are not for diagnosing mental illnesses, but regardless, I still find both fascinating.

 

[clausewitz2]

It is important not to get too caught up in the work of a single scientist or researcher and take it as a gospel that is universally applicable. It is important to have a broader understanding of current consensus, as this is more likely to be closer to empirical reality than any given individual's research program.

Sadly, @smalltownpsych , I think you may be giving medical students too much credit; at this point in our training, the conversations most of my class are having about specialty choice are chiefly salary comparisons. The older non-trad students mostly discuss time off.

 

[Nasrudin]

Ok, microexpressions....the 4 horseman of apocalyptic divorce...meh...I wonder if you're up your Zone Theory.

 

[Bmewriter]

Ok, microexpressions....the 4 horseman of apocalyptic divorce...meh...I wonder if you're up your Zone Theory.

Nah I just want unlimited powaaaaaaaaaaaa.

 

[Asklepian]

The salary survey out there is crap. For example, the salary survey says that psychiatrist on average makes $150,000 a year? That is obviously too low. If you work decent hard and there is some competition out there, you can probably make between $250,000 to $300,000 with a couple potential employers competing for your service. Then beyond $300k a year, you have to work really hard and it is hard for me to conceive a psychiatrist making $500k a year.

Is this kind of money only possible in PP?

 

[jettavr6]

Reality check for the all knowing dogmatic thinking medical students who have commented - The ROAD to success has been carpet bombed and has yet to be paved over. Some know, others don't - I'm a psychiatrist with subspecialty anesthesia based fellowship in pain medicine. I've been in practice for 5 years and interact with my psychiatry, anesthesia, orthopedics, and radiology colleagues on a daily basis many of whom are very good friends. Radiology took the biggest dive with a 40% cut in reimbursement about 2 years ago - Salaries are around $400k if they can find a job. Most of them are working like dogs. Anesthesia keeps getting hit, with job security being a distinct problem as hospitals are trying to purchase groups. Anesthesiologists are making around the $450-500 mark. Orthopedics is still doing well. Spine has taken a hit in recent years. Salary ranges are all over the map - 350k-1.5million. Ophtho and Dermatology are still doing very well, but Ophto did get hit with reimbursement cuts recently. I don't have much data in that regard.

Psychiatry - in a place like Los Angeles, a simple and easy job should make a minimum of 225-250k in a salaried position. Most of the private practice guys that I know are making at least 375k or more. In the big cities, psychiatry is a "prestige" game with a few psychiatrists seeing a lot of the ultra high net worth patients for crazy amounts of cash. Not uncommon for established psychiatrists in Beverly Hills to charge $500-600 an hour - do the math.

Someone spoke of an orthopedist not wanting to do office hours, but rather be in the OR doing cases. Any ortho would laugh at that idea. If you don't see patients in the office during office hours, you'll never have patients to operate on.

 

[jettavr6]

I forgot to add -- looks like Psychiatry is becoming more competitive!

 

[smalltownpsych]

It is important not to get too caught up in the work of a single scientist or researcher and take it as a gospel that is universally applicable. It is important to have a broader understanding of current consensus, as this is more likely to be closer to empirical reality than any given individual's research program.

Sadly, @smalltownpsych , I think you may be giving medical students too much credit; at this point in our training, the conversations most of my class are having about specialty choice are chiefly salary comparisons. The older non-trad students mostly discuss time off.

lol I was actually thinking more of the pre-med undergrad students who want to be a doctor. Maybe the med students are experiencing the effects of high stress on decision-making which leads to simplistic strategies.

 

[Thewonderer]

Reality check for the all knowing dogmatic thinking medical students who have commented - The ROAD to success has been carpet bombed and has yet to be paved over. Some know, others don't - I'm a psychiatrist with subspecialty anesthesia based fellowship in pain medicine. I've been in practice for 5 years and interact with my psychiatry, anesthesia, orthopedics, and radiology colleagues on a daily basis many of whom are very good friends. Radiology took the biggest dive with a 40% cut in reimbursement about 2 years ago - Salaries are around $400k if they can find a job. Most of them are working like dogs. Anesthesia keeps getting hit, with job security being a distinct problem as hospitals are trying to purchase groups. Anesthesiologists are making around the $450-500 mark. Orthopedics is still doing well. Spine has taken a hit in recent years. Salary ranges are all over the map - 350k-1.5million. Ophtho and Dermatology are still doing very well, but Ophto did get hit with reimbursement cuts recently. I don't have much data in that regard.

Psychiatry - in a place like Los Angeles, a simple and easy job should make a minimum of 225-250k in a salaried position. Most of the private practice guys that I know are making at least 375k or more. In the big cities, psychiatry is a "prestige" game with a few psychiatrists seeing a lot of the ultra high net worth patients for crazy amounts of cash. Not uncommon for established psychiatrists in Beverly Hills to charge $500-600 an hour - do the math.

Someone spoke of an orthopedist not wanting to do office hours, but rather be in the OR doing cases. Any ortho would laugh at that idea. If you don't see patients in the office during office hours, you'll never have patients to operate on.

Thank you for saying ortho can even make up to $1.5 million.

Derm is still doing very well with procedures after procedures. Ophthal can still make a lot via volume. They are getting very efficient.

Anesthesia can still make very high salary. I have seen it. The movement toward making the whole group/department out of network and start sticking the insurance company and the patients with out-of-network bill amounts. And balance bill like crazy, while refusing to give in and offer any rate reduction/negotiation with patients who have high deductible plan. The Anesthesia group I had the misfortune of having been involved with, went one step further. I got my surgeon's EOB's and hospital EOB's first 3 weeks of the procedure. Done. They did the surgery and provided the service, and they are in-network so let's get paid. The anethesia's EOB did not arrive until 2.5 months later. That was fishy....why? Because Anesthesia wants all the other claims from the hospital and surgeon get cleared and ANY deductibles are met. Then they will swoop in and take all the fat insurance checks.

As an hypothetical example, Mr. Jones, has a high deductible plans and it is $5000 per calendar year. Because it is high, the out of network and in network deductibles are combined. Mr Jones gets admitted through ER and received emergency surgery. The gas guy and the trauma surgeon are involved. Right after the surgery, the trauma surgeon and the hospital submit their bills right away so Mr. Jones finally hits the deductibles (that $5000 deductibles are met but just not sure if surgeon or the hospital will need to go after the patient for that $5000). Then the gas guy comes in from the side and bang, submit the bill 2.5 months later after all the deductibles have already been made.

In this example, for the procedure involved, say, the gas guy's in-network rate would have been $1200 while the patient is responsible for 10% co-insurance = $120. But now the whole gas group opt'ed out of all insurance plan about 3 months ago so they are now out of network. They can then charge $7000 (insane amount but they don't care. They just want to charge an insane amount just to see how much of the charge ends up "sticking", i.e. considered usual customary). And when the EOB comes back, it says, $4200 is the usual customary and for out of network, co-insurance is 40% and the plan pays 60% so 0.6 x $4200 = $2520. Bang. instead of getting paid a meager $1200 after being locked into an in-network rate, they are now paid twice the amount of their old rate. Then the gas guy gets greedy and come after the patient and balance bill him/her for the missing $1680 to make up the usual customary rate of $4200. You can now forget about reaching anyone from the gas group's front desk person. Instead, they don't have an office and they don't have a desk. The only person you can call is on your collection letter, this 1800 guy on the other side of the coast. And that 1800 person just repeats the same mantra over and over again, as though you will just pay because they keep repeating it.

Now coming after someone for that missing $1680 which is pt's responsibility is totally legal. If you honor the usual customary rate of $4200 that the insurance calculated the benefits based on, then you do need to make reasonable attempt to collect the remaining $1680.

But that is a lot of money nevertheless.

Yes, I just showed you the current and future of many gas groups and their way to make $1 million without becoming a pain guy.

 

[SteinUmStein]

I still don't understand the posters who come back to this forum titled "Psychiatry" to spend significant amounts of time detailing how awesome the rest of medicine is. What is there to gain? If ROAD is so amazing, leave the Psychiatry forum, go pursue a residency in one of those specialties, and go practice. No part of that pathway involves this forum. You can go earn $1 million per year and do fun things that don't involve spending your valuable time here.

 

[MacDonaldTriad]

I can say with complete honesty that if I could turn the clock back three decades, I would go right back into psychiatry without any hesitation what so ever and I have no temptation to pursue any other field in medicine. I would much rather handle “my Xanax” than butt pus or diabetic feet any day. I have never earned an insane amount of money, but I’m comfortable enough and I don’t hate going to work and that is priceless.

I understand why miserable undergraduate physicians focus on the pay issue as a means of justifying their struggle through the process, but this isn’t close to being an end all when it comes to such decisions. It is just easily quantifiable and a transparent factor in the complicated vicissitudes that determine happiness in life. If you find you like psychiatry during your rotations, but will not go into it because your parents disapprove, or your classmates will not respect you, you are a complete idiot and good luck in life. I will find plenty of students to fill our program and it will continue to be insanely easy to find them jobs. Psychiatry rocks and the ribbing we get in the doctor’s dining room is almost completely jealousy driven when you analyze its origins.

The only question is; can you tolerate hearing the following sentence? “I worked so hard to raise you and I girded you from my loins just to have you become the wrong kind of doctor?” If the answer is yes, happiness is just around the corner. Drink the Kool-Aid and join Matthias (1971 Charlton Heston movie, The Omega Man, doesn’t stand up very well, but a lot better than Soylent Green).

 

[smalltownpsych]

I'm thinking psychiatrists might have chosen the specialty because they are interested in human behavior and the CNS and might even enjoy talking to people, too. Although there are always days when we might wish that our patients were anesthesized. I guess the reason it is not competitive is that most med students want to make a million dollars a year and be dermatologists. Seems odd to me but then I never went to med school. Oh not the million a year part, the study of skin part. To each his own.

 

[MacDonaldTriad]

Skin isn’t so bad. I just don’t see developing a passion for treating Bartholin gland cysts. Maybe it is just me, but I don’t think so.

 

[Shikima]

Skin isn’t so bad. I just don’t see developing a passion for treating Bartholin gland cysts. Maybe it is just me, but I don’t think so.

But they're so satifying to lance!