Why the obsession with money?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Anabolic steroids are also such a dumb thing to abuse. You permanently destroy your own testicles and endogenous production in a manner much more straight forward then the way things like alcohol work to reduce baseline Gabanergic functioning. Nothing like having an old raison for a nut so you could briefly appear more muscular.

Now if you are on the juice to make multimillion dollar sports payouts, I at least understand the temptation to dope. But as an everyday person, take some preworkout if you must, hit the weights and move on with whatever body pops out.
That said, the vast majority of anabolic steroid users aren’t athletes. They’re ordinary people using it specifically for the purpose of looking better

Members don't see this ad.
 
  • Like
Reactions: 1 user
That said, the vast majority of anabolic steroid users aren’t athletes. They’re ordinary people using it specifically for the purpose of looking better
I recall that 33 percent of men using swipe apps are using androgenic drugs for the purposes of looking good. Looks are the most important thing in today's world and people are willing to sacrifice their future well being if they can live a glamorous life in youth.
 
This entire thread has become cringey.
 
Last edited:
  • Like
  • Haha
Reactions: 10 users
Members don't see this ad :)
On the whole, with all else being equal, a man who drives a nice car is going to have a higher chance of mating than the man who doesn't.
Care to post the data this bizarre claim comes from? I'm struggling to see how this could be tested or even empiric. Unless you cite some adopted twin studies where they both ended up living in similar areas in the same field making the same money with the same hobbies, and the same interpersonal style, I'm skeptical.
 
Care to post the data this bizarre claim comes from? I'm struggling to see how this could be tested or even empiric. Unless you cite some adopted twin studies where they both ended up living in similar areas in the same field making the same money with the same hobbies, and the same interpersonal style, I'm skeptical.
How much of a jerk does someone have to be that their only chance of finding a good partner is getting a good car?

I have a wife and kids and our cars are horrible by comparison.

Please OP, I'm begging you, don't go into psychiatry. Your patients will hate you.
 
  • Like
Reactions: 1 user
  • Like
Reactions: 1 users
I don't know if its been studied or not, but I think its true. Take the same guy riding around in an '05 Honda Civic and put him in a new BMW and I bet he'll have more success with mating. Perhaps the confidence boost from riding around in such a car is confounding, but perhaps that is part of it.
If you don't know if it's been studied, then you don't know if it's true.

Spoilers: it's true for shallow people.
 
What would you recommend?
I’m driving an old Mazda. All my friends out of residency (non psychiatrists) are going with the German brands. I’m strongly inclined to just go with another Mazda. 😅

If you like Mazda, buy Mazda. Am still driving the same Toyota which has taken me around Australia. Used to do 7-8 hour interstate drives a few times a year when younger so needed something that is reliable and not going to breakdown in the middle of nowhere. Would regularly push 150-160kmph when overtaking large trucks or road trains, as in more remote areas there are stretches of the highway that are single lane so one has to overtake on the wrong side of the road against incoming traffic.

For me, that is the kind of driving I like. It’s the company, planning, working out the rest stops and the playlist is part of the experience. It’s not the daily grind of a stop/start metropolitan drive in heavy traffic. I’m not convinced that more expensive car would improve that daily commute, and for me at least it’d make more sense to hire a supercar at a racetrack.
 
  • Like
Reactions: 1 user
What do you like and not like about your Mazda? Are the things you like in the car you want and are the things you don't want not in them?

They are still relatively more ZoomZoom than their competition (Toyota/Honda/Hyundai/Kia), but each model has pluses and minuses compared to their equivalents.

Miata would still be the most affordable tiny roadster if you want a 2 seater convertible and don't want too many speeding tickets.

CX-5, CX-7 still perfectly fine options for their class. Some competitors are faster, have nicer interiors, or are more economical. Overall still quite fine.

Their sedans are still perfectly fine.

For me: seat comfort, fuel economy, and at least some hint of driving dynamics were most important. So I sat in every model I wanted and anything that didn't feel great was immediately axed. Then I drove all the ones that were comfortable to make sure they were still comfortable while moving. Then I axed all the ones that I didn't like the feel of the steering wheel. Then all the ones that didn't feel fast enough. Then I priced out purchase price, insurance costs, and estimated fuel and maintenance costs. I was left with the Honda Civic EX-L as the frontrunner. So I bought it and now have very minimal desire to buy something else for a long time.

The process is all specific to what you want and what's out there. If I wanted a faster car I would have spent more. If I wanted higher ride height (the thing I like least about the civic - can't see the stoplight if an SUV is in front of me), I would have chosen something else. I know that my friend who drives an R8 is at times jealous of me for being economical, probably similar to my momentary jealousy when I think of how his car has better road feel and is faster. But then I remember that I bought a house and he plans to rent for another 5 years.

Honestly I like the reliability and the fact that you can get a decent amount of safety and luxury features without having to add on expensive packages. I think they look better than most of the German cars. Performance is meh, but my 2016 doesn’t have Turbo. My sisters Audi accelerates like a dream but the steering is so underwhelming, I like the responsive steering of the Mazda. Ohh, it’s affordable too.

The ambivalence comes from…I like that the the image a Mazda projects is moderation and responsibility (in my eyes), but at the same time I’m a new attending and I’m being inundated with that “doctor car” crap. For now I’m my Mazda holds out until I’m ready to get something electric.
 
  • Like
Reactions: 1 users
Honestly I like the reliability and the fact that you can get a decent amount of safety and luxury features without having to add on expensive packages. I think they look better than most of the German cars. Performance is meh, but my 2016 doesn’t have Turbo. My sisters Audi accelerates like a dream but the steering is so underwhelming, I like the responsive steering of the Mazda. Ohh, it’s affordable too.

The ambivalence comes from…I like that the the image a Mazda projects is moderation and responsibility (in my eyes), but at the same time I’m a new attending and I’m being inundated with that “doctor car” crap. For now I’m my Mazda holds out until I’m ready to get something electric.
I think now is one of the best times to be holding onto a fully paid of car and waiting until the next thing comes out and supply chains and the market normalize. That's what I'm doing with my Civic, just waiting for electric cars to have a few more kinks worked out and volume of production high enough.

Every month you wait you're that much closer to being able to fully afford whatever it is you want to buy. Electric cars are going to be much more available, affordable, and better equipped in 3-5 years. Infrastructure will have had that much time to develop, too. You'll also be moving past the impulsive phase of having "doctor money" to spend on a "doctor car," so you won't make the same mistake my dad did in the 90s and buy a Camaro because it was the first car he saw and better than the Geo Spectrum he drove in residency. I have a feeling a lot of the A6, A8, 6 and 7 series owners will suffer similar buyer's remorse
 
  • Like
Reactions: 2 users
We are already in the top 99.9% of earners globally. Why all this obsession to become within the top 99.99%?

Psychiatrists have very high earning power relative to almost any other profession in any other country on the planet and yet here we are debating over who can earn more power/money/prestige when we already have more than any human could want or need.

Seems like people overcompensating for underlying insecurities. We should appreciate how lucky we are to never worry about money the way most on this planet do and yet here we are wondering whether a fellow colleague has a nicer car or slightly more successful business. Money controls the poor and the rich in this way. Only way to break the vicious cycle is to realize this.
I think compared to some other more procedural fields we get paid less well, while we work just as hard and our work is as important. For a long time mental health parity was not a thing which is why psychiatry used to be much less popular. Underlying insecurities? Maybe, because financially we used to and still in some ways are the forgotten child of medicine.
 
Members don't see this ad :)
I think the forgotten child is peds with their horrible pay. Psychiatry is like the kid medicine tried to give up for adoption and later reunited, but still awkward.
 
  • Like
Reactions: 1 users
It seems that psych could be one of the most lucrative fields
No it does not seem that way and is certainly not the case, the most lucrative fields are neurosurgery and other surgical fields (as they should be).
 
  • Like
Reactions: 4 users
Psychiatry will likely never be one of the lucrative fields mainly because of our lack of procedures (TMS can make some money) compared to other specialties. Psychiatry will hopefully end up being a middle of the pack specialty from a financial standpoint especially as mental health parity improves.
 
  • Like
Reactions: 2 users
Does 99214 reimburse over $250 anywhere? 99214 + 90833 might, but in my opinion regularly billing three 99214 + 90833 per hour is probably billing fraud. If 99214 reimburses $250 then three per hour is more realistic.
 
  • Like
Reactions: 1 users
I think now is one of the best times to be holding onto a fully paid of car and waiting until the next thing comes out and supply chains and the market normalize. That's what I'm doing with my Civic, just waiting for electric cars to have a few more kinks worked out and volume of production high enough.

Every month you wait you're that much closer to being able to fully afford whatever it is you want to buy. Electric cars are going to be much more available, affordable, and better equipped in 3-5 years. Infrastructure will have had that much time to develop, too. You'll also be moving past the impulsive phase of having "doctor money" to spend on a "doctor car," so you won't make the same mistake my dad did in the 90s and buy a Camaro because it was the first car he saw and better than the Geo Spectrum he drove in residency. I have a feeling a lot of the A6, A8, 6 and 7 series owners will suffer similar buyer's remorse
If one of our daily cars wasn't dying this is what I would have done. Right now you're generally getting cars well over MSRP that are missing features due to chip availability. When you buy something buy something you want to keep and drive it into the ground
 
Last edited:
I don't know. I've read a few threads on here regarding money. Psychiatrists seem to be very well paid
I don't know how to tell you this, but as others have alluded to psychiatry probably isn't a good field of choice for you, given your interests and proclivities. It also doesn't pay all that well for most. You're usually looking at 250-300k unless you are putting in a lot of hours or spend a few years building your own practice. There's a high ceiling but that is true of any field where you can have others working for you and build a practice to scale. Anesthesia can get you more money working 7-3 than you would earn working 7-7 in psych, more often than not.
 
Last edited:
  • Like
Reactions: 4 users
99214 is reimbursing over $250 in some parts of the country. 30 pts a day. Do the math
I don’t need to do the math I’m actively on the job search and have actually undergone a psych residency unlike you who is still a premed/med student. No, you won’t be making more money in psych than surgical fields most likely unless you’re an extreme outlier. No, you don’t get paid 250 per 99214 that is utter nonsense in the vast majority of cases. We can’t keep having the same conversations that revolve around money and are highly inaccurate.
 
  • Like
Reactions: 6 users
99214 is reimbursing over $250 in some parts of the country. 30 pts a day. Do the math
Not sure psychiatrists should be seeing 30 patients per day.

I can do that in primary care if I really bust my tail but many of my visits are very short (colds, rashes, ankle sprain and so on).
 
  • Like
Reactions: 4 users
Psychiatrists in private practice see a lot of depression and anxiety. How is that different from colds and rashes in terms of time to diagnose and treat?
Please don't go into psychiatry.
 
  • Like
  • Love
  • Haha
Reactions: 14 users
Psychiatrists in private practice see a lot of depression and anxiety. How is that different from colds and rashes in terms of time to diagnose and treat?
You don't seem to understand what is involved in psychiatry. A lot of it is not just, "see depression, prescribe SSRI". You need to actually talk to people, build rapport and trust, and gather a thorough history, and you need to be able to tell in what situations you DON'T prescribe. If you're not doing that you're no better than the NPs and your compensation will reflect that. Also, most of those "easy" cases will also rather see their PCP that they know that can also prescribe an SSRI with 11 refills rather than see you every 3 mos. You'll never build up a good enough practice to get paid $250/pt for 30 pts a day.
 
  • Like
Reactions: 10 users
Although academic salaries are generally much lower than their counterparts in private practice, it made me quite puzzled to see that there are many academic psychiatrists whose total compensation exceed well over 1 million dollar a year and these folks are not world renowned psychiatrists such as Stahl, Schatzberg, Liebermann and Nemeroff ( not that they are not making over a million). It seems there is susbtantial amount of money in consulting and giving promotional speech for drug companies and industry.
 
You don't seem to understand what is involved in psychiatry. A lot of it is not just, "see depression, prescribe SSRI". You need to actually talk to people, build rapport and trust, and gather a thorough history, and you need to be able to tell in what situations you DON'T prescribe. If you're not doing that you're no better than the NPs and your compensation will reflect that. Also, most of those "easy" cases will also rather see their PCP that they know that can also prescribe an SSRI with 11 refills rather than see you every 3 mos. You'll never build up a good enough practice to get paid $250/pt for 30 pts a day.
Yes, this. Also psychiatry and for that matter other fields are not just about seeing patients. There are always calls and refills to manage between appointments, collateral to get, labs to review. A good support staff can help but does not eliminate the time and effort needed to put into this. You also don’t get paid for any of it, though maybe arguably you should and sometimes in private practice you can.
 
  • Like
Reactions: 2 users
Yes. When you're at the top you no longer have to seek out opportunities, they seek you.
You dont have to be in the top necessary. You just need to be a modern day slave of a drug company for the right amount of compensation. I had a supervisor who is an associate professor of psychiatry in a mid tier community hospital affil with a low tier academic center. He was pulling over 5k from a dinner talk for product. If you only do this 20 times a year, that equals to 100k in extra compensation. If you also run industry sponsored trials, you can probably add extra 200k total compensation from stocks and consulting.
 
  • Like
Reactions: 4 users
Certain models are, but most look to plain to me. Some of the Ms and M-lites are fantastic though, hence my pick
I have to agree I have an M240 and love it. Not very expensive (in comparison to many cars) and the performance can easily get you into trouble. But also for someone that has to actually do some driving each day the drive is smooth, and enjoyable.
 
  • Like
Reactions: 1 users
I don’t need to do the math I’m actively on the job search and have actually undergone a psych residency unlike you who is still a premed/med student. No, you won’t be making more money in psych than surgical fields most likely unless you’re an extreme outlier. No, you don’t get paid 250 per 99214 that is utter nonsense in the vast majority of cases. We can’t keep having the same conversations that revolve around money and are highly inaccurate.
To be fair, 99214+90833 however can approach 220 ish where I'm at
 
What locations? Good negotiations will achieve 50% of that number or less in my state.
Also in your state in one of the major cities. Have friends in private practice who are getting low 200s for a 214 plus add on. Not 250, but they're doing well.
 
Although academic salaries are generally much lower than their counterparts in private practice, it made me quite puzzled to see that there are many academic psychiatrists whose total compensation exceed well over 1 million dollar a year and these folks are not world renowned psychiatrists such as Stahl, Schatzberg, Liebermann and Nemeroff ( not that they are not making over a million). It seems there is susbtantial amount of money in consulting and giving promotional speech for drug companies and industry.

You dont have to be in the top necessary. You just need to be a modern day slave of a drug company for the right amount of compensation. I had a supervisor who is an associate professor of psychiatry in a mid tier community hospital affil with a low tier academic center. He was pulling over 5k from a dinner talk for product. If you only do this 20 times a year, that equals to 100k in extra compensation. If you also run industry sponsored trials, you can probably add extra 200k total compensation from stocks and consulting.
Doing dinner talk for 5k a year is not that easy to get for EVERY other week of the year.

It's not that easy to make 1M a year in psychiatry, regardless of how prestigious you are. We had this discussion many times. There are really only two tried and true methods to achieve this: 1. run a very large and high volume practice. 2. run a very small but really expensive cash practice. All these other methods (pharma, consulting, high-end admin, blah blah) are not reliably revenue-generating, and counting on those to try to make a lot is really like shooting for lottery tickets. And even those two tried and true methods, if you want to make a lot of money, you'd have to be dedicated, lucky, persistent, and have the right background.

If you really enjoy the lifestyle of a pharmaceutical executive or hospital admin, go for it, but know that making reliable money is not necessarily better in those pathways. I've been on the hiring and applying side of BOTH and the numbers are truly not great. It's actually shocking how little you get paid for a mostly terrible job. Imagine instead of seeing 20 patients a day, you have 20 Zoom calls with employees a day, then you get evaluated by a KPI with which you have little influence. That's your job.

If I manage people I want to see DIRECT results of my management. When you are a manager in a large system, whether you do well or not is not reflected in your compensation.

That being said, none of this (even running a business) is an optimal way to get rich. I made a lot of money in 2020/2021, but none from compensation for labor. You need passive income/capital appreciation to become wealthy. The sooner you realize this the better. And nobody cares what car you drive. And I *mean* nobody. I have patients who are spouses of wealthy people, and if you think that attractive women are dumb enough to care what car you drive, you are truly naive. The only patient I had who cared about what car he drives is a service provider for wealthy people who needed to pretend that he's doing well and he's dropping out of my practice because he can't afford me. Don't be that guy.
 
Last edited:
  • Like
Reactions: 4 users
Right. That includes an add-on with a time component. Can’t do 30 of those in an 8 hour day.
Definitely not..two per hour grossing 420-430 an hour before the overhead of a lean tele hybrid practice is more than enough for me. That should net 500k a year seeing 12-14 per day.
 
  • Like
Reactions: 1 user
The sooner you realize this the better. And nobody cares what car you drive. And I *mean* nobody. I have patients who are spouses of wealthy people, and if you think that attractive women are dumb enough to care what car you drive, you are truly naive. The only patient I had who cared about what car he drives is a service provider for wealthy people who needed to pretend that he's doing well and he's dropping out of my practice because he can't afford me. Don't be that guy.

I have a few very successful and wealthy patients who definitely were invested in particular prestige brands of automobile, but they were all first-generation immigrants from Africa or the Middle East who really, really needed to be seen as That Cousin Overseas Who Is Rich. They felt that in their local communities of people from the Old Country there would definitely be whispers if they had a serious downgrade of automobile for any reason. But their kids didn't have much patience for this and were very eager to escape their parents' community for this and other reasons, even the ones who were doing well for themselves.
 
Perception of car you own largely depends on location and subculture.

Yes, in NYC, most wouldn't care, and probably would feel sorry for you if you're driving an expensive car in the city.
Don't think it's the same in, say, San Diego. People really care there about displays of wealth.
 
  • Like
Reactions: 1 user
Agreed though with the dinner talks, typically they "bunch" talks up. IE give a dinner talk Thursday in X town, give another one Friday at town Y 45 minutes away. Or give a lunch talk for a group practice and then give a dinner talk that night, etc. So rather than flying out every other weekend there's a circuit and you fly out every month or two.

Anyone with experience in this realm know how to get started? I enjoy psychopharm and speaking, but not sure how to even seek out opportunities like this.
 
I'm waiting for someone here to start describing reasons why thats not possible
1. That's assuming a 0% no-show rate. 10% would still be low, but a big cut right there.
2. That's assuming 100% collections. That can be hard to achieve for many practices.
3. That's assuming every payer pays that amount, not a mix of several with lower payments.
4. That's assuming a full panel with no intakes or discharges, which doesn't really happen at any point in a practice.
5. It takes a long time to fill a panel / schedule to that degree.
6. Depending on the demographics, as much as 30% of people tend to no-show intakes. So making no money and not adding a patient to your practice takes away a lot of potential payments.
7. Intakes would take up the slot for at least 2 follow-ups and pay much less per hour, even when attended.
8. Patients are always going in and leaving, so you need to account for that long-term attrition.
9. Not every consult leads to a follow-up. You need to account for an immediate attrition rate.
10. Fourteen 30-minute follow-ups per day can be exhausting, especially if there are major trainwreck cases. How many intakes are you also going to have that day?
11. Seven clinical hours + lunch + admin time is often a lot longer than 8 hours. I would rather take a longer lunch and cut an hour off the beginning and end of the day.
12. It's hard to run lean enough to have no employees if your panel is ~600. Honestly, it's hard outside of the practices that are very heavy on psychotherapy (~50).
13. Even if your practice is 500 patients, that's at least 500-750 hours of intakes, if 100% of consults led to a perfect follow-up case to bill 99214+90833.
14. Not everyone needs a 99214+90833. Forcing them into that isn't good medicine and is also insurance fraud. Seeing stable adult ADHD without any comorbidities is almost always a 99213, and there might not be any indication for the add-on. Same thing with any other stable single-problem visits.
15. Not a terribly huge market for people wanting to see a telepsychiatrist but who also want someone local who still doesn't have an office for occasional in-person visits.
16. If you aren't local, why would someone want to see you over any other non-local?
17. No controlled substances for tele-only. Even if you like that aspect, it does mean you're limiting your clientele.
18. If you're tele-only, why would someone choose to see you instead of any of the companies that already offer this service?
19. How many days did you calculate working per week? I would much rather work 4 days a week with at least 6 weeks of not working per year. Four 6-hour days (10-4, working through lunch) a week is only 24 hours per week. That's more like 4 intakes and 40 follow-ups per week, assuming 100% show rates.
20. 24 hours per week x 46 weeks is 1,100 hours a year. Subtract at least 600 hours the first year for intakes, and even if you max out the remaining 500 hours that year, it's only 500 hours at that rate.
21. Factor in the above attrition rates, it looks nowhere near as nice as initially described.
 
  • Like
Reactions: 7 users
1. That's assuming a 0% no-show rate. 10% would still be low, but a big cut right there.
2. That's assuming 100% collections. That can be hard to achieve for many practices.
3. That's assuming every payer pays that amount, not a mix of several with lower payments.
4. That's assuming a full panel with no intakes or discharges, which doesn't really happen at any point in a practice.
5. It takes a long time to fill a panel / schedule to that degree.
6. Depending on the demographics, as much as 30% of people tend to no-show intakes. So making no money and not adding a patient to your practice takes away a lot of potential payments.
7. Intakes would take up the slot for at least 2 follow-ups and pay much less per hour, even when attended.
8. Patients are always going in and leaving, so you need to account for that long-term attrition.
9. Not every consult leads to a follow-up. You need to account for an immediate attrition rate.
10. Fourteen 30-minute follow-ups per day can be exhausting, especially if there are major trainwreck cases. How many intakes are you also going to have that day?
11. Seven clinical hours + lunch + admin time is often a lot longer than 8 hours. I would rather take a longer lunch and cut an hour off the beginning and end of the day.
12. It's hard to run lean enough to have no employees if your panel is ~600. Honestly, it's hard outside of the practices that are very heavy on psychotherapy (~50).
13. Even if your practice is 500 patients, that's at least 500-750 hours of intakes, if 100% of consults led to a perfect follow-up case to bill 99214+90833.
14. Not everyone needs a 99214+90833. Forcing them into that isn't good medicine and is also insurance fraud. Seeing stable adult ADHD without any comorbidities is almost always a 99213, and there might not be any indication for the add-on. Same thing with any other stable single-problem visits.
15. Not a terribly huge market for people wanting to see a telepsychiatrist but who also want someone local who still doesn't have an office for occasional in-person visits.
16. If you aren't local, why would someone want to see you over any other non-local?
17. No controlled substances for tele-only. Even if you like that aspect, it does mean you're limiting your clientele.
18. If you're tele-only, why would someone choose to see you instead of any of the companies that already offer this service?
19. How many days did you calculate working per week? I would much rather work 4 days a week with at least 6 weeks of not working per year. Four 6-hour days (10-4, working through lunch) a week is only 24 hours per week. That's more like 4 intakes and 40 follow-ups per week, assuming 100% show rates.
20. 24 hours per week x 46 weeks is 1,100 hours a year. Subtract at least 600 hours the first year for intakes, and even if you max out the remaining 500 hours that year, it's only 500 hours at that rate.
21. Factor in the above attrition rates, it looks nowhere near as nice as initially described.
I think this about covers it.

It’s a much much too rosey picture. You need to cut that number down a solid 20% just from #1-4.

If you want to gross 500k you better be shooting for 600-700k under the best circumstances. And then also remember your take home post tax will be much lower yet.
 
  • Like
Reactions: 1 user
Does 99214 reimburse over $250 anywhere? 99214 + 90833 might, but in my opinion regularly billing three 99214 + 90833 per hour is probably billing fraud. If 99214 reimburses $250 then three per hour is more realistic.

Medicare will reimburse $184 for a 99214 in Alaska, maybe if there's great insurance coverage up there you could get $250?
 
Ty. I’ll have to check out MyStrength’s module. I’ve not yet been able to get insurance to cover it but $100 with a coupon and works with an FSA/HSA.
I didn't realize until I googled it just now to follow-up on how to access it outside of our system. It looks like they mostly contract with different healthcare companies to give their patients an "access code." You might not be able to get access as an individual consumer unfortunately. I hadn't realized since some of our other digital app partnerships can be purchased by individual consumers.
 
Top