Why isn't psychiatry considered a "lifestyle" specialty?

[rs2006]

Hi everyone,

I hope your interviews are going well. Whenever people talk about the typical lifestyle specialties, they talk about the ROAD specialties such as rads, ophtho, anesthesia, and derm, but psych is never mentioned amongst them. Why is that?-- Psych seems to have alot to offer in that regard-- namely pretty good pay for number of hours worked, little to no call, and minimal to near zero malpractice which if you ask me in this day and age is HUGE plus. Any thoughts? thanks.

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[Milo]

Shhh, stop telling everyone.

 

[nortomaso]

Hi everyone,

I hope your interviews are going well. Whenever people talk about the typical lifestyle specialties, they talk about the ROAD specialties such as rads, ophtho, anesthesia, and derm, but psych is never mentioned amongst them. Why is that?-- Psych seems to have alot to offer in that regard-- namely pretty good pay for number of hours worked, little to no call, and minimal to near zero malpractice which if you ask me in this day and age is HUGE plus. Any thoughts? thanks.

The ROAD specialties pay much more than psych. The also involve a more strict application of knowledge than psych, relying on pattern recognition and the following of algorithms. The kind of person who is attracted to this kind of predictable high-paying routine is generally quite the opposite of the typical psych enthusiast. In the same vein, psych involves a lot of high intensity, even dangerous, patient encounters and a proximity to the depths of human misery that you will not see in those specialties. There is also a stigma attached to both mental illness and mental health care providers that does not sit well with those primarily concerned with a stable, cushy career. Finally, psych is an immature field in terms of how much we know. There is absolutely no way you can cruise on what you learn in your training and remain competent, nor can you simply apply knowledge without venturing to experiment a little. In sum, stability is the hallmark of the ROAD specialties, instability the defining characteristic of psych and mental illness. Those attracted to the latter tend to be adventure seekers, those to the former like adventure too, but only behind the wheel of a new SUV, not at work.

 

[Poety]

What a great response Norto - well said!

 

[OldPsychDoc]

....In the same vein, psych involves ....a proximity to the depths of human misery that you will not see in those specialties....

norto--have you never dealt with an acne-riddled adolescent?

 

[nortomaso]

norto--have you never dealt with an acne-riddled adolescent?

Good point, OPD. Maybe you should found a new branch of psychosomatic medicine: psychodermatology.

Sound like a money-maker?

 

[Anasazi23]

I believe there was already was a journal dedicated to that very subject, and it is the subject of research at U. of Florida. It's becoming more prevalent in research at other institutions, and there's quite a bit on the web about it.
Here's a just a brief start.
http://www.aafp.org/afp/20011201/1873.html
http://www.medpharm.co.za/safp/2001/june/pshycho.html
http://www.cambridge.org/catalogue/catalogue.asp?isbn=0521542294

I, too, am interested in this topic. I've done quite a bit of reading on the dermatological manifestations of psychiatric illness and the dermatological effects of psychotropics. I was very interested in derm during medical school and would have been even more so as a career if it didn't involve selling your first born to get into it. I plan on doing a lot of my own derm when I'm in practice. It's interesting stuff.

 

[prominence]

I plan on doing a lot of my own derm when I'm in practice.

how so?

 

[Anasazi23]

how so?

Within my comfort zone, I plan to do so by managing some dermatological manifestations of psychiatric illness, treat (I already do) adverse dermatological to medications I prescribe, etc.

I could do a mattress stitch in surgery with the best of 'em, but won't be attempting that in my psych private practice.

You get good at prescribing permethrin and lindane when you do an urban psychiatry residency.

 

[mamabear]

In general they probably do pay more, but I have spoked with at least half a dozen psychiatrists in private practice--this is in Texas--and they all charge 200 per hour. The claim to make well over 300k per year, and considering that they pay little in malpractice compared to anesthesia (or maybe even rads), don't they come out better? Perhaps this information should remain unknown. If this isn't the norm, please say so.

The ROAD specialties pay much more than psych.

 

[The Pride]

In general they probably do pay more, but I have spoked with at least half a dozen psychiatrists in private practice--this is in Texas--and they all charge 200 per hour. The claim to make well over 300k per year, and considering that they pay little in malpractice compared to anesthesia (or maybe even rads), don't they come out better? Perhaps this information should remain unknown. If this isn't the norm, please say so.

The ROAD specialties pay much more than psych.

I think that the academic salaries are significantly more in ROAD than Psych. Meanwhile, in private practice, you can definately make the kind of money you're talking about but it may largely be dictated by your business management skills. And you have to be good enough that people are willing to pay most of that out of pocket. And that goes not just for psych; I know a group of private practice general pediatricians (also in TX) that net around $250K/yr working about 30/hr week.

 

[mstevens]

In general they probably do pay more, but I have spoked with at least half a dozen psychiatrists in private practice--this is in Texas--and they all charge 200 per hour. The claim to make well over 300k per year, and considering that they pay little in malpractice compared to anesthesia (or maybe even rads), don't they come out better? Perhaps this information should remain unknown. If this isn't the norm, please say so.

The ROAD specialties pay much more than psych.

I don't know a single psychiatrist who bills by the hour except for court time or such (mine is $300/hour, minimum of 4 hours). The closest procedure to an hour for me is 90801 ("Psychiatric Diagnostic Evaluation") at $285 or 3 to 4 90862 "med checks" at $85 each. It is possible to bill more per hour doing hospital followup visits if you (and the entire team) are very organized. It's not very difficult to bill an average of $250 an hour while seeing patients through the work day. What I bill and what I collect, though, are entirely different animals. Add to that unreimbursable hours (on the phone with patients' daughters, insurance companies, etc., attending meetings, travelling between locations, fending off drug reps, and so on) and the hourly drops more. Even for a psychiatric practice with a small staff, expenses mount up as well. I have a practice net of around $185k/year on annual billings of around $380k. That includes my medical and other insurance, retirement contribution, etc. but not personal income taxes. I spend about 40 hours a week actually working, 46 weeks a year.

I used to moonlight for a private psychiatrist in a Houston suburb who had a practice income of around a million a year (in the early 90's). This depended on 1) his relationship with a private for-profit hospital that was raided by the FBI for fraud 2) maintaining an inpatient census of 40-60 patients at any given time and 3) using large numbers of employed extenders including me to allow him to bill for more patients than he was capable of seeing. He worked, at a minimum, more hours per week than I did with my residency plus moonlighting. I used to meet with him at 9PM when he got out of the office. There is not enough money in the world to justify working like that if you don't have to.