Why isn't Psychiatry more competitive?

[vin5cent0]

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[Whatyousay]

Negatives: One of your patients may decide to follow you home.

 

[Web MD]

lol u crazy

 

[luli]

I just don't think it would be that interesting. Also, I noticed my insurance provider doesn't cover many psychiatrists, mostly PMHNPs. But if you don't want to work with insurance companies then that's not important.

 

[searun]

As I recall, Dr. Richard Seltzer, the author of "Confessions of a Knife," referred to psychiatrists as the "Nuns of the Medical Profession." Of course, Dr. Seltzer, was a surgeon, although not arrogant by any means. Also, your response to this characterization will depend in large part on your feelings about nuns who generally get mixed reviews from the medical profession.

 

[cowme]

To sum it up:

Short / easily obtained residency

Easy private practice transition

Relatively easy workload and nice hours

Rather large potential incomes

Funny how you didn't mention ONE thing about the science of psychiatry and the patient interaction that attracts you. Having a great lifestyle and hourly pay rate is nice and all, but if you don't actually love how you are spending the majority of your week, you are going to be miserable. Psych is a great gig, but most med students are not into the "physical exam with the mind," and seeing severely depressed patients who never respond to meds.

EDIT: your numbers are way off. Psychiatrists, on average, don't make much more than 200-250K. That said, they do have a great lifestyle

 

[jab8220]

Your observation is a small area where you live which seems to be an upscale area. People pay cash because insurance companies will no longer pay for talk therapy from a psychiatrist; only for medication management. A recent New York Times article indicated that only 11% of psychiatrist currently perform talk therapy. Therefore in lower and middle class areas, a psychiatrist has to see 4 patients an hour at a much lower rate. Of course they still make money but the workload is much heavier. What you are seeing is a small portion of the specialty.

 

[DrBowtie]

275,000 gross - minus overhead - taxes.

You are assuming you can find a clientele that is willing to pay $275/hr.

 

[MeowMeowCAT]

Simply put, because it is often a very depressing job. You have to be very strong emotionally, especially since a lot of the patients will most likely have a lot of stuff to talk about, and will go in excruciating detail about whatever is bothering them. And not everyone wants to leave work at the end of the day feeling like **** as a human being and be constantly realizing "Damn, and I thought I had it bad in my life."

Yes, the pay is nice, but the job will likely emotionally drain you.

 

[ponyo]

There are definitely plenty of psychiatrists who make a ton. You would just have to be significant better than everybody else in your field. This might seem like it's an easy thing to do since psych isn't exactly known for attracting the best and brightest of the medical industry but the job is pretty ridiculously hard. Esp. if you're trying to actually help your pts through talk therapy... Speaking as an ex counselor you seriously have to have the patience of God to keep from stabbing some of these people in the face.

Simply put, because it is often a very depressing job. You have to be very strong emotionally, especially since a lot of the patients will most likely have a lot of stuff to talk about, and will go in excruciating detail about whatever is bothering them. And not everyone wants to leave work at the end of the day feeling like **** as a human being and be constantly realizing "Damn, and I thought I had it bad in my life."

Yes, the pay is nice, but the job will likely emotionally drain you.

And yea it's depressing as hell. They come. They get angry because you can't help them. You can't figure out how to help them because there actually is no way, or at least no way that anybody has figured out. Then they kill themselves and you feel like **** and their family walks around town telling everybody about how it was your sheer incompetence that killed their loved one. Or, slightly better, pt gets better and tries his best to never think of your existence again.

 

[DoctwoB]

To sum it up:

Short / easily obtained residency

Easy private practice transition

Relatively easy workload and nice hours

Rather large potential incomes

Thoughts? The only negatives I can think of are "Prestige", and building up a client base. If you're pulling in over half a million a year, you probably couldn't really care less about prestige. On top of that, Psych offers "repeat" clients that will continuously be coming back week after week. I have a feeling that once you establish a client base, you probably have a fairly reliable set of clients. I have no interest in the field myself, but it has been making me wonder lately why others don't pursue this route.

The upper middle class psychiatrist who gets $350/hr cash for talk therapy upfront for treating upper middle class problems is a rarity, and you better believe that getting/keeping gigs like that is highly competitive, especially in heavily saturated metropolitan areas.

Many psych patients are poor and on medicaid or uninsured, and they will make up a large part of the patient pool.

Psych makes decent money (~200k, though that's assuming you do more prescribing and less therapy, which pays less), with a good lifestyle and a wide variety of ways to practice. People are catching onto this, and more people are applying for psych then ever.

That being said, you really need to love psych to find it fulfilling as a career. I would be miserable as a psychiatrist, as would many of my classmates. I would much rather work 7 days on, 7 days off as a hospitalist and make similar money (though the "on" days are much more intense")

 

[tn4596]

wow come on
most of ur patient will not kill themselves jeez, and most people usually just go there for something like depression i guess you just give em like a prescription drugs or sleeping pill or something depend on situation.
listenning to patient is not that hard, just imagine how some people had endure listenning to their wives all their lives lol
srly, being a psychiatrist sound like an awesome job to have

 

[Mattchiavelli]

Honestly, if you do child psych you can have a pretty lucrative practice that is cash only and have people lined up to see you in almost any market...the wait to get in to see a child psych is obscene.

Also most psychiatrists do a 15 minute visit for established patients because a lot of what you will do is med management. It is definitely a lifestyle specialty and people in the field don't have any qualms about it.

Final thing- if anyone thinks they get to avoid dealing with psychiatric illness by not being a psychiatrist, you have another thing coming.

 

[Evidence Based]

Psych is no more or no less "depressing" than any other field. You have people you can help and people you can't, just like you do in IM, surgery, or any other field. And with regards to violence, if I remember correctly, EM docs and PCPs face comparable levels of violence to psychiatrists (http://www.ncbi.nlm.nih.gov/pubmed/10646917).

More fact checking: insurance companies do in fact reimburse psychiatrists for therapy, some just choose not to do it because medication management is more lucrative.

Frankly, I'm sure the biggest deterrent to people entering the field is the patient population. Dealing with the mentally ill (especially the severe and chronic patients) can be very difficult. Additionally, unlike most other specialties, diagnostic categories are a bit vague (you can't order a lab and have it come back positive for schizophrenia). I think this frustrates many people.

That being said: dude stop blabbing! Psych is secretly an amazing specialty in which you can have great job satisfaction, great pay, and reasonable hours. Why would you ruin that be telling everyone else about it? Sheesh. I'm content to let it be the secret lifestyle specialty without everyone else waking up to it.

 

[kexy]

Don't psychiatrists take call from their patients?

 

[Geekchick921]

I think a lot of people would rather treat something a bit more... tangible than mental illness. I personally don't think I would enjoy that specialty for various reasons.

Also, pretty much every psychiatrist I've ever interacted with during my time working at a hospital has seemed a little off themselves. Their patients seem to rub off on them. JME.

 

[Eric01]

Well I would say the pay isn't as great as other specialties which is primarily the number one reason it isn't more competitive.

Also there is an enormous amount of frustration because all of your patients are dealing with chronic illness. Things that typically don't respond to an acute treatment. Also the aspect of dealing with people who are in a state of psychosis or deep depression makes for a very difficult encounter. (I'd imagine)

 

[vin5cent0]

Are people really going to argue that Dermatology is incredibly interesting to everyone who applies for it...?

My take on a lifestyle specialty is that it provides the lifestyle you want, but not necessarily your ideal job. Obviously both would be preferable, but that's not often possible.

And yeah, I do realize my sampling is rather small around here, but I don't live in a big, ritzy town by any means.

 

[qwerty89]

Psychiatry can be a VERY lucrative field...if you know which areas *cough prison systems cough* pay the best.

Not to mention those employees oftentimes get benefits...which include vacation, good health insurance oh and a pension (since they work for the county/state).

 

[TheMightySmiter]

OP, ever been on a psych ward? Psych patients are depressing as he'll...it takes a special kind of person to be able to handle that. Psychiatrists are not therapists, they work with a lot of heavy problems and mental illnesses. It's not something I'd ever choose unless I loved the work.

 

[docelh]

Okay, so at the ED on Monday, there was a psych. ward patient high on meth.

Nurse note:

Had to leave the patient's room because he was openly masturbating.



Funny stuff to read. Difficult stuff to deal with.

 

[Stumpyman]

My uncle is a very well renowned psychiatrist, he makes close to 300k a year, I am pretty interested in the psychiatry field as well actually.

 

[Stumpyman]

Also, pretty much every psychiatrist I've ever interacted with during my time working at a hospital has seemed a little off themselves. Their patients seem to rub off on them. JME.

Definitely. Everyone in my family keeps a somewhat distance from my uncle (psychiatrist), they say he's gone a bit crazy himself. I believe it's because a lot psychiatrists sell drugs to places like jails and asylums, which may or may not take a serious mental toll....

 

[MeowMeowCAT]

Would a lot of work with psychiatry also make a person somewhat more "paranoid"? I mean you whole job revolves around basically reading people, trying to understand how and why they are acting or saying things a certain way. I would assume after some time it would be difficult to not "take your work with" and maybe develop some sort of issues when communicating with other people because you would be too used to "reading" them.

Maybe this is what you guys mean about the people you know who are psychiatrics to be "odd". I would assume it would be somewhat uncomfortable communicating with such a person without feeling lile you are being treated as a patient.

Just assumptions though...

 

[ponyo]

wow come on
most of ur patient will not kill themselves jeez, and most people usually just go there for something like depression i guess you just give em like a prescription drugs or sleeping pill or something depend on situation.
listenning to patient is not that hard, just imagine how some people had endure listenning to their wives all their lives lol
srly, being a psychiatrist sound like an awesome job to have

If you've ever had a friend who killed themselves you would know that one is enough. And listening in a way that actually helps the other person is ridiculously difficult.

And giving people pills doesn't help them that much and there are so many family members who get angry about it. If you don't prescribe they stay depressed. If you prescribe husbands/wives/kids blame you for making their loved one a "zombie".

As for prison systems... ever spoken to actual psychopaths? It's an experience...

Even for child psych... when I was working at this children's mental health center I had this one kid scream continuously for my entire work day. I got bitten maybe 2, 3 times a day, often to the point where I'd bleed... And then there are the kids who just sit all day staring at a wall or rock back and forth like Harlow's monkeys and it just breaks your heart.

I still really love psych though... it's definitely a specialty I'm considering. :/

 

[loveoforganic]

Still considering C&A psych. Will have to rotate through it. My experience thus far is depressing. At least 50% of the patient base seems to be made up of kids who have just gotten all of the world's $hit thrown in their faces. Witnessing violent crime, intense neglect/abuse, rape, etc, often as preteens. You get to do your best for them, then they get to go back to the dysfunctional family that isn't going to be able to adequately care for them. Never enough resources available for mental illness. Just not a national priority. Want to help them, just don't know if I'm strong enough. There's always pediatric oncology and pediatric PM&R...

 

[Deathstar]

Psychiatry is definitely an interesting field. It's a field where you can build long-lasting relationships with your patients and you can touch and change the lives of many. I have a soft spot for people who are misunderstood and just needs someone to listen to them. I dunno the things you deal with seem cool, but my perception may be idealized. The only drawbacks I can think of is salary (I don't see them making a lot of dough unless you set up a private practice, but then you won't see the good stuff. You'll get the depressed and ADD people but not disorders like schizo). The other drawback is that you're dealing with the mind and it's hard to help people as well you would like to. I have a lot of time to make up my mind but so far psychiatry definitely looks viable.

 

[music2doc]

OP, you seem pretty naive about psychiatry, to be honest. First, many psychiatrists do take call. Many psychiatrists are employed in a hospital setting (i.e., in-pt psychiatry) and/or do consults for the ED. The psychiatrists I worked with often saw as many as 15-20 pts/day and pulled 10-12 hr days 5 days/wk plus weekend call and administrative duties.

In addition, psychiatrists and others in the mental health professions tend to have relative short lifespans compared with other healthcare professions. (I don't recall where I saw this but it was interesting.)

The pay is generally around $250k (not $700k).

Psych deals with the toughest of pts (in multiple respects). It is a field that can be disheartening and not at all rewarding (unless you're the right kind of person).

It seems as if, from what I've gathered, that Psych is kind of the joke specialty around here. Their pay in academia sucks, you work with people who may or may not be crazy all day, etc. It seems to me, though, that Psych has some really great things going for it. Feel free to argue the point if you think it's wrong, I'm curious about other opinions on this.

First and foremost, the leading reason why I believe Psych can be a very lucrative field is the simple fact that it's far and away the easiest specialty to run a private practice in. Think about it. You need no specialty tools that I can think of (start up costs are extremely low). From what I've personally witnessed, you essentially need to rent out perhaps 1 room and a reception area in a building and you have all that you need. What other specialty can really do that?

Once you've accomplished that, you have a relatively easy job (depending, of course, on what kind of work ethics you're willing to put in). You have no call, you set your own schedule, and your job literally consists of sitting down at a desk with a patient and hashing things out for an hour at a time.

SO, so far we have a specialty that

A) can be extremely easy to transition into private practice

and

B) can give you the kind of lifestyle many would like (no call, flexible hours, and money (getting to that) ).

Now, let's talk money. From what I've personally witnessed, an established Psychiatrist or Psychologist can get away with charging upwards of $350/hour in my area. Keep in mind that I live around the Mayo Clinic, so competition with them is probably pretty fierce already.

So, $350/hour. You might have a receptionist (probably a good idea) that you pay pretty poorly. You owe rent for the office you're renting out. Other than that, you'll have the typical bills, such as insurance, and that's about it.

I have a sister that used to go see a psychiatrist over her extreme shyness years ago. I recently asked my parents what they paid, and I was told about $280/hour over ten years ago.

What got me thinking about this is a recent experience of mine. My fam. doctor recommended I go see a psychologist over some sleep issues that I was having. I went to the guy's website to book my appointment and saw that he was booked solid, with 8 slots a day, for over 2 weeks. I made and appointment, and then called to confirm. I stupidly never thought to ask about a price, and was slapped with a $350 bill. Even more crazily, he didn't accept insurance. You had to fight it out with your insurance if you wanted reimbursement. This guy had a rented office, an older lady at a desk, and that was about it. He is grossing $2800 a day. Work 50 weeks a year and that's $700,000 a year before taxes and expenses, assuming you're pulling in patients every day to fit your schedule, which he seemed to be doing. I also thought the guy was a real ***** when I spoke with him, and he did absolutely nothing to help me or even follow up with me after. Yet he's able to pull in tons of patients.

Now, I realize he's on the higher end of the payscale in my area, and that assuming you'll have 8 patients every day is probably unrealistic. Let's assume you only work 4 hours a day (4 slots to fill), and charge $275 an hour. You're still pulling in $275,000 a year (gross) working half the hours that most people do (and probably a third of the hours that most doctors work).

To sum it up:

Short / easily obtained residency

This probably should not be. Psych ought to be a much tougher residency to ensure residents learn psych testing and modalities thoroughly....

Easy private practice transition

Do you want to be protected? You generally would want more staff than other clinics (not less)

Relatively easy workload and nice hours

This varies by location (as with any specialty)

Rather large potential incomes

sure, but so do family practice docs

Thoughts? The only negatives I can think of are "Prestige", and building up a client base. If you're pulling in over half a million a year, you probably couldn't really care less about prestige. On top of that, Psych offers "repeat" clients that will continuously be coming back week after week. I have a feeling that once you establish a client base, you probably have a fairly reliable set of clients. I have no interest in the field myself, but it has been making me wonder lately why others don't pursue this route.

 

[katarina90]

Just had to post since I'm a med student (hopeful future psychiatrist) and also the daughter of a psychiatrist.

First of all, one of the things that is incredibly true about a lot of the responses is that it's an incredibly stressful job and it takes a toll not only on yourself but on your family. There is a lot of patient noncompliance in psychiatry, many of it secondary to financial reasons stemming from their illness precluding them from keeping a job.

Second of all, you will most likely be on call. Most psychiatrists are on call at least some point in their careers, and 'on call' in psychiatry is some pretty heavy stuff. Midnight calls because your patient is growing agitated/violent, etc.

Third, while it isn't a very competitive specialty as a whole, keep in mind that the prestigious psych residencies (MGH, etc.) are going to still be super-competitive.

And finally, though this is an issue in any branch of medicine, it is true in psych that one will sometimes have to deal with patients that are sometimes combative and violent. Obviously you will take precautions to protect yourself, but there are times when things still happen.

If you can get through all of this though, it is an incredibly rewarding job. You will help a lot of people get their lives back into order, and develop a huge sense of satisfaction from it. That said, it's definitely not for everyone.

 

[katarina90]

Forgot to add that you are not going to make 275 an hour from every patient or even most patients. Aside from boutique private practices, most of them will be paying with insurance.

Some of them, especially the ones you will encounter in the hospital due to an emergency, will not have insurance at all, or the means to pay out of pocket.

However, depending on how much one works, it is definitely potentially lucrative as with all branches of medicine.

 

[JohnMathews]

I personally rather be an oncologist or surgeon of some type rather than a psychiatrist, simply because it does not appeal to me. But if you like it then go ahead.

 

[MaenadsDance]

Your idea of compensation is off. The psychiatrist I currently see - who I pay out of pocket, as he doesn't accept insurance - charges 150 an hour, with a sliding scale for patients with financial difficulty. This is in a metropolitan area with a fair amount of competition from other practitioners. Additionally, he regularly works from 8 am to 9pm, 6 days of the week, and gives his cell phone number to his patients to call him any time, night or day. This is fairly typical in my experience with psychiatrists - although many in private practice don't have "call" as such they handle emergency calls from their patients at any time, night and day, through their personal phones.

If I didn't have psychiatric issues of my own, psychiatry is absolutely a field I would be interested in, though. It's a fascinating field with a lot of room for important research and improvement, and there's such tremendous need for good psychiatrists.

 

[Starlightembers]

Psychiatry is not, by any means, an easy field to be in - including those who are in private practice; or, rather, it's an incredibly hard specialty to do well. If you wanted to do your job poorly then psychiatry is likely the easiest field to do that in. No, there are no machines or tools to set up; but that, in many ways, is what makes it so difficult. There are no easy cures, simple answers or straightforward treatments; you have a handful of psychiatric medication and psychotherapy (though, many/most don't practice therapy, something I don't particularly agree with) and a lot of uncertainty. Though this is, of course, true to some extent in any branch of medicine, it is particularly true in psychiatry. Despite what you seem to think, you can't just sit there and hand over prescriptions and then send them on their way - not if you want to be effective, anyways. There is so much more involved than that and, especially in a private practice setting, you will be dealing with patients in some way long after you go home. You will get called late at night by a patient who is suicidal, psychotic or becoming agitated/aggressive and have to try to talk them down, get them to go to an ER or find some other way to manage the crisis. As others have already pointed out, your information on compensation is way off, as well. Though it will vary, you'd be more likely to receive $50 - $160 an hour. Keep in mind, many of your patients will be on Medicaid, other forms of government-supported insurance or completely uninsured, as well. Even with patients that have good converge, most insurance companies don't like compensating you for your time (this is true in any field; but especially psychiatry) and you will run into countless times when the insurance company refuses to pay for your suicidal patient's SSRI and/or hospitalization - heck, I've heard of cases where they have even refused to transport the person from an ER to the nearest psychiatric hospital (once again, this is with all specialties to some extent; but, from what I can tell, it is more pronounced in psychiatry).

Once again, you will always find exceptions; but, I have never payed more than $50 to see my psychiatrist for about an hour and that was during lapses in my insurance (Medicaid, bureaucratic BS; I'm pretty sure he was more or less unofficially sliding scale, as well - he knew we wouldn't be able to pay more than that). I also have his cell phone number and, back when I was unstable, there were a few times where I was on the phone with him past 10:00pm (both relating to hospitalizations); I have called at numerous, not-so-late hours as well. And, though I like to think that I'm an easy patient to deal with now (as seeing that I am essentially recovered, with little to no symptoms), this was not always true. I was never aggressive or violent or towards him - though, I am sure he has patients that are - but I wasn't all that calm and articulate, either, and presented with behaviors that scared all involved at times.

On that note, if you can get past all that, I think psychiatry is a really great field; but not because of any amazing lifestyle or salary. I think it's a great field because, even though there will be patients you can't help or who flat out don't want your help, the opportunity for long-term relationships with patients and the ability to make the type of difference you can in psychiatry just isn't there in other fields. And, even though I know some people wouldn't recommend due to my history, it is definitely a field that I could see myself very, very happy in (and, now that I am essentially 100% stable).

Star

 

[Old Grunt]

Do your psych rotation and then make up your mind about the field after you've had some exposure. Academically, I found the field of psychiatry to be the most interesting to study and the material just inherently stuck. "I got it".

Pragmatically, I walked out of our psych hospital more depressed every day. For various reasons. For me, it was the fact that there is nothing more depressing then the concept of someone losing control of their mental facilities. When you start going down that wormhole, you start staring at some very ugly realities. Then there were the "behavior problem" patients who you had to walk on eggshells with lest you say the wrong thing and take a beating before the orderlies get there. God forbid you stomp a mudhole in their ass in self-defense, because they are "sick" and get to get away with assault and battery.

I am not knocking the profession or the merits of what they do. I am grateful for the field. It just wasn't for me. I am glad some people love it.

You should think about it from that aspect. As noted on here, if you think your life as a psychiatrist is going to consist of treating the Housewives of Wisteria Lane, you probably haven't really done a lot of research on what the field is/does.

 

[QuizzicalApe]

I'll agree with the folks who have said things to the effect that Pysch is a very easy specialty to coast along in doing poorly, but it is very difficult to do well.

To offer a competing viewpoint to the folks who left Psych rotations feeling depressed every day, I always left my rotation feeling pretty chipper. I spent time working in a unit devoted to relatively acute issues (folks just coming out of treatment for suicide attempts, overdose/withdrawal, or in the grip of a major depressive/manic episode), as well as in an adolescent unit.

Working with the depressed and suicidal was actually more of a pick-me-up than the kids. I worked there long enough that I was able to build relationships, establish trust, and get to the point where I felt that just having the time to sit down with these folks was helping them. And I worked there long enough to see their improvement over time, to see them hopeful and smiling at discharge.

That's a really good feeling.

The kids were a little more draining; less so the kids themselves, although they can be frustrating because it was rare to have them there by choice, but more the way that the adolescent unit tended to be an extended stay hotel for kids with problems who had been abandoned in the hospital by their parents.

It was basically a place for kids to stay while an agency tried to find a place to put them until they turned 18.

Went home enjoying the crap out of my own life, though. Teaches you to be grateful!

 

[Chir0nex]

I spent last year working at a psychiatric hospital and had many conversations with doctors about their experience in psychiatry because it is something that I am quite interested. Here is some of what they said on the topics at hand...

Success at private practice also depends on your location. In major cities you can usually charge a bit more and have a stable client pool. However, in smaller towns and cities it can be very difficult to build up enough patients for a new practice if there are already multiple therapists in the area. Related to this is that it is becoming more and more difficult to control your own practice. Medicare and insurance has very limited coverage for psychotherapy or really any non-medication based psychiatric treatment. If you want to conduct client centered therapy you need to have a large population of affluent patients who can pay out of pocket.

Also, to everyone who thinks that psychiatry is low stress or easy, you are just wrong. Coping with your inability to truly cure much of the illness you see, seeing the lives of your patients fall apart, and putting up with the irrational all take their tole. There is a reason that psychiatrists in training are required to be in therapy themselves.

All that being said, I think psych is great, and challenges you to really develop a strong bedside manner. It is much harder to develop the skills to be an outstanding psychiatrist than almost any other specialty because you can't learn people skills from a book, each time it is different and requires creativity on your part.

 

[Morsetlis]

Psychiatry in a hospital pays less than private psychiatry.

Of course, as with all private office medicine, you will have to find your own clientele and market yourself, something most people don't know how to do.

I experienced psychiatry in a hospital and it's like trying to explain biochemistry to middle school students. All day. The slightest thing you do could piss somebody off, and you could also spend 15 minutes trying to talk to somebody and they end up ignoring you. And then there's people who try to touch you.

 

[Bartelby]

The lifestyle is good if you want it to be (look up average hours by specialty, psych is one of the lowest). The pay is fair as far as medical specialties go (~$200k is pretty easy to pull). Residency is also not that competitive at most places. If you do it for the money with mild or no interest in the patients, though, I think you will find yourself miserable. If you're not the right person for the job some psych patients can be annoying, scary, or even disgusting to you. If you are the right person for the job each day is pretty amazing and the prospect of helping people through the kind of mental crises you see regularly really speaks to you.

So basically check it out for yourself. If you like the work it can be one of the best fields (in my opinion) in many respects.

 

[Starlightembers]

Related to this is that it is becoming more and more difficult to control your own practice. Medicare and insurance has very limited coverage for psychotherapy or really any non-medication based psychiatric treatment. If you want to conduct client centered therapy you need to have a large population of affluent patients who can pay out of pocket.

Having Medicare and insurance companies pressure you is different than having them control you. You are right, the coverage is limited and the compensation isn't as great as it should be; however, in private practice, from everything I know, there is still choice in the matter. The psychiatrist I see does therapy with the majority, if not all, of his patients and takes almost any insurance, including government-supported insurance (Medicare, Medicaid, government-subsidized, etc). He rants all the time about the BS from insurance companies; but it still doesn't change the way he practices.

I agree with everything else you said, though.

 

[Hastur]

As many have said here - there are those who work in private practice for affluent clients, yes, and their lives are probably not so hard, but there are also those who work for gov't mental health care systems - where help is most desperately needed and funding is often cut.

Nonetheless it's easily among the specialties I could see myself going into. A good psychiatrist is like a tech support op for brain chemistry, and I appreciate that sort of thing.