Any predictions as to why or when psychiatry is going to crash? Everyone is talking about a boom, bubble, and burst cycle.

[SmallBird]

When I was a resident responding to these threads I was accused of being overly optimistic. As a young attending in academics who continued to feel positive the feedback was that I was not practicing in the real world. Now 5 years in I am working for a large non-academic system in the middle of the country and continue to feel very good about my compensation. At this point either 1) it remains possible to do very well in this field, or 2) I am having a fever dream.

There are clearly a range of pressures that impact the nature of our work and how we are paid. If you are looking for job where you there is an extremely low change of slight change over time, then you should probably just not get a job at all. If you are looking for a job where you will have an above average ability to determine the nature of what you do, a robust employment market, the likelihood of a high starting salary, but some need to display flexibility and creativity in demonstrating value, then psychiatry offers a reasonable balance overall.

I do think it is going to be difficult to make $500k a year as a psychiatrist if you insist on resisting all quality improvement directives from your senior leadership and provide identical clinical services to an NP. I have continued to do well by ensuring that I can leverage the strengths of my training to complete my work more efficiently, achieve a higher volume, accept some increased risk, and constructively engage with institutional efforts at how to best run services. I have never, ever had to stay at work after 5pm, I have never been told to how much time to spend with a patient, what med to pick, or how to do therapy, and I make more money than the 50% percentile for dermatology. It just isn't so bad and if you don't believe me we have openings here.

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[Mad Jack]

Psych residents have increased or all residency slots?

Psych resident positions are up over 80% compared to the early 2000s

 

[Mad Jack]

I'm wondering what data or trend would actually reassure people that this isn't happening or likely to happen? I mean so many people have hard evidence that salaries are doing great and yet there's still so much anxiety. I don't get it.

People were saying the same thing about emergency medicine when I was in med school in 2014. I tried to point out the facts and no one listened, now they're at a point of oversaturation 8 years after they were pulling 500k for 12 shifts a month

 

[Mad Jack]

When I was a resident responding to these threads I was accused of being overly optimistic. As a young attending in academics who continued to feel positive the feedback was that I was not practicing in the real world. Now 5 years in I am working for a large non-academic system in the middle of the country and continue to feel very good about my compensation. At this point either 1) it remains possible to do very well in this field, or 2) I am having a fever dream.

There are clearly a range of pressures that impact the nature of our work and how we are paid. If you are looking for job where you there is an extremely low change of slight change over time, then you should probably just not get a job at all. If you are looking for a job where you will have an above average ability to determine the nature of what you do, a robust employment market, the likelihood of a high starting salary, but some need to display flexibility and creativity in demonstrating value, then psychiatry offers a reasonable balance overall.

I do think it is going to be difficult to make $500k a year as a psychiatrist if you insist on resisting all quality improvement directives from your senior leadership and provide identical clinical services to an NP. I have continued to do well by ensuring that I can leverage the strengths of my training to complete my work more efficiently, achieve a higher volume, accept some increased risk, and constructively engage with institutional efforts at how to best run services. I have never, ever had to stay at work after 5pm, I have never been told to how much time to spend with a patient, what med to pick, or how to do therapy, and I make more money than the 50% percentile for dermatology. It just isn't so bad and if you don't believe me we have openings here.

Oh the market is *great* now, I'm talking about 10-15 years from now

 

[FlowRate]

People were saying the same thing about emergency medicine when I was in med school in 2014. I tried to point out the facts and no one listened, now they're at a point of oversaturation 8 years after they were pulling 500k for 12 shifts a month

For reference, number of residency positions in 2000 and 2020 for three specialties. (Just had a few minutes to whip something up.) Last column is % increase (multiply by 100).

	2000​	2020​
Psych	771​	1858​	1.409857​
EM	851​	2655​	2.119859​
IM	4377​	8697​	0.986977​

 

[calvnandhobbs68]

People were saying the same thing about emergency medicine when I was in med school in 2014. I tried to point out the facts and no one listened, now they're at a point of oversaturation 8 years after they were pulling 500k for 12 shifts a month

Emergency medicine is a very very different field. This has been discussed other places but there are a lot of factors that contributed to ER oversaturation including: PE/private hospital groups intentionally opening up residency programs to increase supply/drive down wages/get cheap labor; EM being tethered to the emergency room and having no other options for practice besides this; EM increasingly being a field where you "supervise" 4-5 NPs in the ED which also drove down demand; Private groups buying contracts for multiple/all hospital systems in the area so there is basically no competition in an area, thus dictating wages for an entire geographical region.

 

[VA Hopeful Dr]

Emergency medicine is a very very different field. This has been discussed other places but there are a lot of factors that contributed to ER oversaturation including: PE/private hospital groups intentionally opening up residency programs to increase supply/drive down wages/get cheap labor; EM being tethered to the emergency room and having no other options for practice besides this; EM increasingly being a field where you "supervise" 4-5 NPs in the ED which also drove down demand; Private groups buying contracts for multiple/all hospital systems in the area so there is basically no competition in an area, thus dictating wages for an entire geographical region.

The biggest difference is that you can't open up your own ER wherever you want. Hospitals will increase the size of their ERs from time to time but as a whole that doesn't result in a huge increase in demand.

 

[VA Hopeful Dr]

Psych resident positions are up over 80% compared to the early 2000s

And yet the soonest I can get a patient in to see a psychiatrist is 3 months. And this is in a fairly small state with 3 psych residency programs.

 

[Mad Jack]

And yet the soonest I can get a patient in to see a psychiatrist is 3 months. And this is in a fairly small state with 3 psych residency programs.

I think we're good for 20 years or so, at least. Who knows though

 

[TexasPhysician]

So soon?

It’s all relative and effects some not well positioned. Covid did this to many. Many psychiatrists flooded online telepsych companies. Some of these companies offered $75 per follow-up (no guarantee). When psychiatrists flooded the system, they began earning $25/hr. There were so many that psychiatrists previously busy dropped to 1 follow up every 3 hours. Few wanted the in-person jobs.

 

[whopper]

Was going to add all this "psychiatry is going to burst" talk is a load of BS.

It's as relevant as asking "when will the orthopedic bubble burst?" What? People aren't going to break bones anymore? Or there'll be no need for eye doctors cause all of a sudden Kryptonian DNA will prevent the need for eye treatment?

What makes people think it's a bubble that's going to burst? NPs? Most states they'll need a physician to supervise them. Also while I have seen very good and competent NPs they're very few and far between.

My 4th year of medical school an IM doctor told me some device was going to come out making psychiatry irrelevant? What device? You mean that metal cap you saw on that sci-fi show? There is no device. Maybe that IM doctor should've seen a psychiatrist for treatment of delusions.

 

[Merovinge]

Reimbursements decrease and staff and other costs increase. Where are you seeing increased reimbursement and decreased overhead?

Over the past 50 years (that's 2019 in yellow above), salaries have slightly outpaced inflation, not been eaten away at by inflation. Turns out being an MD in the USA has long been a very high salary position field, both compared to other fields (although modern tech clearly outpaces medicine) and compared to the rest of the world.

I am not seeing decreased overhead anywhere, but every cash pay psychiatrist I know (which is somehow a lot more than I expected 5 years ago), has raised their rates annually or every two years to at least match inflation and cost increases and have remained with near 0 availability in their practices. Salaried docs I know, myself included, continue to see average numbers push up Y-o-Y.

 

[FlowRate]

Over the past 50 years (that's 2019 in yellow above), salaries have slightly outpaced inflation, not been eaten away at by inflation. Turns out being an MD in the USA has long been a very high salary position field, both compared to other fields (although modern tech clearly outpaces medicine) and compared to the rest of the world.

I am not seeing decreased overhead anywhere, but every cash pay psychiatrist I know (which is somehow a lot more than I expected 5 years ago), has raised their rates annually or every two years to at least match inflation and cost increases and have remained with near 0 availability in their practices. Salaried docs I know, myself included, continue to see average numbers push up Y-o-Y.

There's a study I've looked for approximately once a year for the past 8 years but haven't been able to find it again. (I read it about 9-10 years ago, during first or second year of med school.) They looked at physician income (grouped as general practitioners and specialists) in many different countries and compared those incomes to the distribution of incomes in those countries. Generally, GP's earned between 92nd and 96th percentile income for their country and specialists earned 94th to 98th percentile. So physicians on average generally make 95th percentile income for their country. It's unsurprising to me that we continue to make approximately that much (or more, US was on the higher end.)

I tried looking into replicating at least parts of the studies a couple of times but turns out a lot of countries do not have that data (exact income distribution, not just quartiles/quintiles; breakdown of physician income by specialty) as readily available as we do in the US. Especially when you start looking for data on countries where English isn't the primary language.

 

[PikminOC]

Over the past 50 years (that's 2019 in yellow above), salaries have slightly outpaced inflation, not been eaten away at by inflation. Turns out being an MD in the USA has long been a very high salary position field, both compared to other fields (although modern tech clearly outpaces medicine) and compared to the rest of the world.

I am not seeing decreased overhead anywhere, but every cash pay psychiatrist I know (which is somehow a lot more than I expected 5 years ago), has raised their rates annually or every two years to at least match inflation and cost increases and have remained with near 0 availability in their practices. Salaried docs I know, myself included, continue to see average numbers push up Y-o-Y.

My friends work for corporate hospitals and I see their Rvu numbers decrease over time so they are doing more work for the money. Do you work for the VA?

 

[PikminOC]

Over the past 50 years (that's it2019 in yellow above), salaries have slightly outpaced inflation, not been eaten away at by inflation. Turns out being an MD in the USA has long been a very high salary position field, both compared to other fields (although modern tech clearly outpaces medicine) and compared to the rest of the world.

I am not seeing decreased overhead anywhere, but every cash pay psychiatrist I know (which is somehow a lot more than I expected 5 years ago), has raised their rates annually or every two years to at least match inflation and cost increases and have remained with near 0 availability in their practices. Salaried docs I know, myself included, continue to see average numbers push up Y-o-Y.

Your graph doesnt put in the cost of overhead. I have seen overhead increase over the reimbursement increases. And student loans are much higher now which can't be ignored. Much higher rate of increase than the 70s compared to the salary bump.

 

[PikminOC]

When I was a resident responding to these threads I was accused of being overly optimistic. As a young attending in academics who continued to feel positive the feedback was that I was not practicing in the real world. Now 5 years in I am working for a large non-academic system in the middle of the country and continue to feel very good about my compensation. At this point either 1) it remains possible to do very well in this field, or 2) I am having a fever dream.

There are clearly a range of pressures that impact the nature of our work and how we are paid. If you are looking for job where you there is an extremely low change of slight change over time, then you should probably just not get a job at all. If you are looking for a job where you will have an above average ability to determine the nature of what you do, a robust employment market, the likelihood of a high starting salary, but some need to display flexibility and creativity in demonstrating value, then psychiatry offers a reasonable balance overall.

I do think it is going to be difficult to make $500k a year as a psychiatrist if you insist on resisting all quality improvement directives from your senior leadership and provide identical clinical services to an NP. I have continued to do well by ensuring that I can leverage the strengths of my training to complete my work more efficiently, achieve a higher volume, accept some increased risk, and constructively engage with institutional efforts at how to best run services. I have never, ever had to stay at work after 5pm, I have never been told to how much time to spend with a patient, what med to pick, or how to do therapy, and I make more money than the 50% percentile for dermatology. It just isn't so bad and if you don't believe me we have openings here.

You have your notes completed by 500 pm? Where do you work?

 

[Merovinge]

Your graph doesnt put in the cost of overhead. I have seen overhead increase over the reimbursement increases. And student loans are much higher now which can't be ignored. Much higher rate of increase than the 70s compared to the salary bump.

I agree about the cost of medical school, this has grown very disproportionately and does make the overall investment a worse deal now than then, however it doesn't change the reality of actual salaries which was the initial discussion point.

The graph does not include overhead because it is detailing salary. For employed physicians this would be total financial compensation and for private practioners it would be total take-home pay, which does account for overhead (every PP doc I know has revenue-overhead=take home).

There has been some reduction in RVU pay per RVU after the increased RVUs per patient changes that occurred in 2021 but this does not mean there is more work for less pay (as things were just changed so the same work generated more RVUs). I can imagine doctors are being asked to see more patients for the same pay over time, I just don't know where the data is for this, I do think it's part of the ongoing erosion of the practice of medicine by corporate (and population) influences.

 

[PikminOC]

Over the past 50 years (that's 2019 in yellow above), salaries have slightly outpaced inflation, not been eaten away at by inflation. Turns out being an MD in the USA has long been a very high salary position field, both compared to other fields (although modern tech clearly outpaces medicine) and compared to the rest of the world.

I am not seeing decreased overhead anywhere, but every cash pay psychiatrist I know (which is somehow a lot more than I expected 5 years ago), has raised their rates annually or every two years to at least match inflation and cost increases and have remained with near 0 availability in their practices. Salaried docs I know, myself included, continue to see average numbers push up Y-o-Y.

Looks like the salary for psych are only a little bit more than the 1970s adjusted.

 

[CB5T]

There's a study I've looked for approximately once a year for the past 8 years but haven't been able to find it again. (I read it about 9-10 years ago, during first or second year of med school.) They looked at physician income (grouped as general practitioners and specialists) in many different countries and compared those incomes to the distribution of incomes in those countries. Generally, GP's earned between 92nd and 96th percentile income for their country and specialists earned 94th to 98th percentile. So physicians on average generally make 95th percentile income for their country. It's unsurprising to me that we continue to make approximately that much (or more, US was on the higher end.)

I tried looking into replicating at least parts of the studies a couple of times but turns out a lot of countries do not have that data (exact income distribution, not just quartiles/quintiles; breakdown of physician income by specialty) as readily available as we do in the US. Especially when you start looking for data on countries where English isn't the primary language.

That's a refreshing way to look at it. Basically the way I interpret what you gleaned from that study is that physicians, by factor of having pursued a rigorous course of training that limits supply, do well in their respective economies the world over. So that inflation can hit us. Practice pressures can hit us. The technology will change. Like small bird said, those of us who stay flexible and creative, will fare better, but still..... all of us in all fields will not be washing dishes, roofing, or driving a cab, anytime soon. Or. Ever. nice.

 

[PikminOC]

Your graph doesnt put in the cost of overhead. I have seen overhead increase over the reimbursement increases. And student loans are much higher now which can't be ignored. Much higher rate of increase than the 70s compared to the salary bump.

Still the psych salary is not much more 5han the 70s adjusted rates. Certainly doesn't look like it even keeps up with inflation for 40 years. I used an inflation calculator. Should be 302,600$ today.

My hospital friends and patients say that they need a larger number if rvu to keep the same salary from year to year.

 

[SmallBird]

You have your notes completed by 500 pm? Where do you work?

Still the psych salary is not much more 5han the 70s adjusted rates. Certainly doesn't look like it even keeps up with inflation for 40 years.

My hospital friends and patients say that they need a larger number if rvu to keep the same salary from year to year.

Why do patients need RVUs at all?

 

[SmallBird]

You have your notes completed by 500 pm? Where do you work?

That's been the case everywhere I've worked. Say you have 11 inpatients. 2 intakes - 25 min interviews. 3 briefer follow ups - 30 min total. 3 follow ups with therapy - 90min. 1 more messy patient - 30min. 2 discharges - 1 hour. Total patient time: 4.5hrs. 2 - 3 hours to document. About 25 RVUs, home by 5. At $64/rvu, 230 days a year = $368k. What's the trouble?

 

[PikminOC]

That's been the case everywhere I've worked. Say you have 11 inpatients. 2 intakes - 25 min interviews. 3 briefer follow ups - 30 min total. 3 follow ups with therapy - 90min. 1 more messy patient - 30min. 2 discharges - 1 hour. Total patient time: 4.5hrs. 2 - 3 hours to document. About 25 RVUs, home by 5. At $64/rvu, 230 days a year = $368k. What's the trouble?

Do you write notes at work or afterwards? On call? Np supervisor?

 

[PikminOC]

Why do patients need RVUs at all?

The patients? This is the way hospitals measure productivity by these points. And what about the salaries not increasing by much except for surgery?

 

[MacDonaldTriad]

Small bird makes the right point. I'm really wondering why this income discussion isn't looking better than it has ever been. If you are not happy or if you are disappointed in your training outcome, you are doing it wrong. This will not get better than it is now because this is remarkable. Enjoy and stop being chicken little. Everyone's pessimism is never unjustified if taken out to an unlimited period of time, there will be better times if you extend the period being considered to infinity, but it seems ridiculous to my perspective and I have done this for a long time. It doesn't get better than it is now so stop complaining. Things are better than ever. What do you want and what isn't up to your expectation? Pay is keeping up if not surpassing inflation and we should be thankful. Most people are hurting and we are not. I can't imagine our complaining to our friends and family and getting much sympathy. Man up, and go to work, and enjoy your income. No one will feel sorry for us. Don't complain about your loans. No one will be sympathetic. You will be fine. Complaining will not strengthen you position among friends. Like Arnold Swartzneger said, "don't be girlie men". We should understand that we are very fortunate. You can only feel sorry for yourself if you are looking at high end specialties. We do well enough.

 

[SmallBird]

The patients? This is the way hospitals measure productivity by these points. And what about the salaries not increasing by much except for surgery?

You said in your post that your hospital friends AND PATIENTS are having to do more RVUs then ever which I didn't understand

 

[SmallBird]

The patients? This is the way hospitals measure productivity by these points. And what about the salaries not increasing by much except for surgery?

I write notes at work. I feel good about the care I deliver. And I won't say where I work because every time I've made the case that things don't suck people say it's just the one place I work that happens to be ok. But I've now worked in 4 states for very different systems and yes there are frustrations but it remains very possible to 1) deliver good care; 2) get home by 5 and 3) make a lot of money.

 

[PikminOC]

You said in your post that your hospital friends AND PATIENTS are having to do more RVUs then ever which I didn't understand

I have friends from medical school and separately patients who are physicians who complain about the same issues in corporate medicine.

 

[PikminOC]

I write notes at work. I feel good about the care I deliver. And I won't say where I work because every time I've made the case that things don't suck people say it's just the one place I work that happens to be ok. But I've now worked in 4 states for very different systems and yes there are frustrations but it remains very possible to 1) deliver good care; 2) get home by 5 and 3) make a lot of money.

I'm not saying it's just your place. Everyone has different experiences.

 

[PikminOC]

Still the psych salary is not much more 5han the 70s adjusted rates. Certainly doesn't look like it even keeps up with inflation for 40 years. I used an inflation calculator. Should be 302,600$ today.

My hospital friends and patients say that they need a larger number if rvu to keep the same salary from year to year.

Did no one see number I get from the inflation calculator? It's much higher than the graph

 

[PikminOC]

Small bird makes the right point. I'm really wondering why this income discussion isn't looking better than it has ever been. If you are not happy or if you are disappointed in your training outcome, you are doing it wrong. This will not get better than it is now because this is remarkable. Enjoy and stop being chicken little. Everyone's pessimism is never unjustified if taken out to an unlimited period of time, there will be better times if you extend the period being considered to infinity, but it seems ridiculous to my perspective and I have done this for a long time. It doesn't get better than it is now so stop complaining. Things are better than ever. What do you want and what isn't up to your expectation? Pay is keeping up if not surpassing inflation and we should be thankful. Most people are hurting and we are not. I can't imagine our complaining to our friends and family and getting much sympathy. Man up, and go to work, and enjoy your income. No one will feel sorry for us. Don't complain about your loans. No one will be sympathetic. You will be fine. Complaining will not strengthen you position among friends. Like Arnold Swartzneger said, "don't be girlie men". We should understand that we are very fortunate. You can only feel sorry for yourself if you are looking at high end specialties. We do well enough.

Compared to the 70s, there's alot of nonsense physicians have to deal with that wasn't present in the 70s.

 

[docksan]

Compared to the 70s, there's alot of nonsense physicians have to deal with that wasn't present in the 70s.

And a lot of things that make doing paperwork by 5pm pretty easy.

 

[Merovinge]

Did no one see number I get from the inflation calculator? It's much higher than the graph

That data is from 2019 not 2022 which is why you are seeing the difference, no one has up to date data without spending money on MGMA or MD recruitment firms for what the last few months has looked like.

 

[CB5T]

Small bird makes the right point. I'm really wondering why this income discussion isn't looking better than it has ever been. If you are not happy or if you are disappointed in your training outcome, you are doing it wrong. This will not get better than it is now because this is remarkable. Enjoy and stop being chicken little. Everyone's pessimism is never unjustified if taken out to an unlimited period of time, there will be better times if you extend the period being considered to infinity, but it seems ridiculous to my perspective and I have done this for a long time. It doesn't get better than it is now so stop complaining. Things are better than ever. What do you want and what isn't up to your expectation? Pay is keeping up if not surpassing inflation and we should be thankful. Most people are hurting and we are not. I can't imagine our complaining to our friends and family and getting much sympathy. Man up, and go to work, and enjoy your income. No one will feel sorry for us. Don't complain about your loans. No one will be sympathetic. You will be fine. Complaining will not strengthen you position among friends. Like Arnold Swartzneger said, "don't be girlie men". We should understand that we are very fortunate. You can only feel sorry for yourself if you are looking at high end specialties. We do well enough.

Well said.

Also, as I treat my colleagues from other specialties, I don't see anything to envy. If anything, I get the sense that they look at my independence, my cushy office, my sense of meaning in spending more time with patients, my everything, and think to themselves why they didn't consider our field.

To your point, I demure with revealing how good my life is. I would never consider complaining even to them. Much less in front of someone who lost work because of the pandemic or who might get laid off soon with impending recession.

 

[PikminOC]

That data is from 2019 not 2022 which is why you are seeing the difference, no one has up to date data without spending money on MGMA or MD recruitment firms for what the last few months has looked like.

Pls someone look at an inflation calculator. I looked at many: $270,000 in 1970 is worth $1,779,059.92 in 2019.
This may be wrong. Please tell me what you find. Mine could be wrong. I checked several.

 

[splik]

Pls someone look at an inflation calculator. I looked at many: $270,000 in 1970 is worth $1,779,059.92 in 2019.
This may be wrong. Please tell me what you find. Mine could be wrong. I checked several.

Why did you put in $270k for 1970? If you plug in $40 000 in 1970 (which I think was what the chart was showing) that would be something like $270k is 2019.
Not to mention federal income tax was very high back then. After 40k, the marginal tax rate was 48%, at 200k it was 70%!

According to the Data from the AMA psychiatrists earned a little under 40k in 1970 and by 1976 the gulf between psychiatrist pay and physicians at large became substantial.

 

[jbomba]

Small bird makes the right point. I'm really wondering why this income discussion isn't looking better than it has ever been. If you are not happy or if you are disappointed in your training outcome, you are doing it wrong. This will not get better than it is now because this is remarkable. Enjoy and stop being chicken little. Everyone's pessimism is never unjustified if taken out to an unlimited period of time, there will be better times if you extend the period being considered to infinity, but it seems ridiculous to my perspective and I have done this for a long time. It doesn't get better than it is now so stop complaining. Things are better than ever. What do you want and what isn't up to your expectation? Pay is keeping up if not surpassing inflation and we should be thankful. Most people are hurting and we are not. I can't imagine our complaining to our friends and family and getting much sympathy. Man up, and go to work, and enjoy your income. No one will feel sorry for us. Don't complain about your loans. No one will be sympathetic. You will be fine. Complaining will not strengthen you position among friends. Like Arnold Swartzneger said, "don't be girlie men". We should understand that we are very fortunate. You can only feel sorry for yourself if you are looking at high end specialties. We do well enough.

We're in a field filled with neurotic, overthinkers. What did you expect? Lol.

 

[Mad Jack]

That's been the case everywhere I've worked. Say you have 11 inpatients. 2 intakes - 25 min interviews. 3 briefer follow ups - 30 min total. 3 follow ups with therapy - 90min. 1 more messy patient - 30min. 2 discharges - 1 hour. Total patient time: 4.5hrs. 2 - 3 hours to document. About 25 RVUs, home by 5. At $64/rvu, 230 days a year = $368k. What's the trouble?

With dictation I've seen 3 new inpatients and 18 follow-ups and been out by 5 a couple of times. Literally is the difference between being out at 5 and out at 9 for me.

 

[bGMx]

It's fun to think about and can feel productive, especially when we're right, but even our most advanced climate modeling can't predict the climate further out than a handful of months. For the nitty gritty, the European model for weather is only able to predict out to 14 days, and even that is dubious at best. These models have huge data sets of very non-removed, not meta-physical rules governing weather and climate patterns. We small party of distinguished online men and women certainly don't know what anything will look like in a decade.

 

[SmallBird]

It's fun to think about and can feel productive, especially when we're right, but even our most advanced climate modeling can't predict the climate further out than a handful of months. For the nitty gritty, the European model for weather is only able to predict out to 14 days, and even that is dubious at best. These models have huge data sets of very non-removed, not meta-physical rules governing weather and climate patterns. We small party of distinguished online men and women certainly don't know what anything will look like in a decade.

Agree we can't predict the future. I think the more interesting argument is 1) are things worse now than they were; 2) is it feasible to do well now (I think it is); 3) are hospital administrators inevitable forces who will always have priorities that work against our interests - I don't think so.

 

[PikminOC]

Why did you put in $270k for 1970? If you plug in $40 000 in 1970 (which I think was what the chart was showing) that would be something like $270k is 2019.
Not to mention federal income tax was very high back then. After 40k, the marginal tax rate was 48%, at 200k it was 70%!

According to the Data from the AMA psychiatrists earned a little under 40k in 1970 and by 1976 the gulf between psychiatrist pay and physicians at large became substantial.

With dictation I've seen 3 new inpatients and 18 follow-ups and been out by 5 a couple of times. Literally is the difference between being out at 5 and out at 9 for me.

Lots of places have removed transcriptionists.

 

[finalpsychyear]

Simply put. If you want to protect yourself for the future of the field you should be doing the following:
1. Saving min 100k which includes pre,post, company matching, savings yearly. I would urge you to shoot for 40-50% gross imo if you feel like your going to retire before 50 and especially in years where you just made more will balance other years where you make less or spend more.

2. If you don't have a PP then wherever you work you need to grab admin positions just as CMO or medical director spots. That's the only protection you have over admin replacing you with a few NPs to boost their income.

To be fair this applies to most non procedural fields with the threat of midlevels replacing them. Surgical specialties and rads are likely immune for the foreseeable future but then again they do a lot of things NPs can't quite do yet but that may change since NP scopes/stents are starting to be done years ago in certain academia places etc.

While I may not retire at 50, I only look at 3-5 years ahead at a time and thus have been doing all of the above. I also believe living like a resident (50k-60k gross spending) the first 5 years of attending life and investing every dime was key to getting me nearing some lower level FIRE numbers. I do rent in all fairness but i was told not to count your house towards these fire goals but that advice may be controversial and now that their may be some correction in prices I may look into that over the next 12 mo when housing prices bottom. Still adjusting to married life pushing my yearly spending slightly over 100k now lol.

 

[brazilianpsych]

Maybe some people are just slow typers? As I resident, I usually carry around 6 patients and my notes are done before noon. I could easily write 12 notes before 2pm. Honestly, I could probably finish them by noon as well. I don't understand how someone can take that long to write notes, but on the other hand I do have co residents who will take hours and hours to write notes. They will write a lot about useless things tho.

 

[jbomba]

Maybe some people are just slow typers? As I resident, I usually carry around 6 patients and my notes are done before noon. I could easily write 12 notes before 2pm. Honestly, I could probably finish them by noon as well. I don't understand how someone can take that long to write notes, but on the other hand I do have co residents who will take hours and hours to write notes. They will write a lot about useless things tho.

Yeah I don't get it. I generally have clinic notes 90% done during the visit. I could have 12 pts in a day and not stay past five either.

 

[FlowRate]

That's a refreshing way to look at it. Basically the way I interpret what you gleaned from that study is that physicians, by factor of having pursued a rigorous course of training that limits supply, do well in their respective economies the world over. So that inflation can hit us. Practice pressures can hit us. The technology will change. Like small bird said, those of us who stay flexible and creative, will fare better, but still..... all of us in all fields will not be washing dishes, roofing, or driving a cab, anytime soon. Or. Ever. nice.

I think the underlying forces are many and varied but the trend is that physicians make top decile income pretty much globally. We are among the most rare, desired, and useful of all service sector jobs.

With dictation I've seen 3 new inpatients and 18 follow-ups and been out by 5 a couple of times. Literally is the difference between being out at 5 and out at 9 for me.

I'm curious, is your dictation system super accurate or do you just live with errors? I find dictation helpful for converting my sentence fragment hpi notes that I take during intakes into a cogent narrative but the errors are hard to catch/fix without slowing down so much that I might as well type.

 

[Mad Jack]

Lots of places have removed transcriptionists.

I use electronic dictation through Dragon

 

[Mad Jack]

I think the underlying forces are many and varied but the trend is that physicians make top decile income pretty much globally. We are among the most rare, desired, and useful of all service sector jobs.

I'm curious, is your dictation system super accurate or do you just live with errors? I find dictation helpful for converting my sentence fragment hpi notes that I take during intakes into a cogent narrative but the errors are hard to catch/fix without slowing down so much that I might as well type.

I use Dragon and it works well as long as you're using a good mic. It will actually adapt to your speech over time, I'd say there's maybe one error every 5 sentences or so.

 

[SmallBird]

Simply put. If you want to protect yourself for the future of the field you should be doing the following:
1. Saving min 100k which includes pre,post, company matching, savings yearly. I would urge you to shoot for 40-50% gross imo if you feel like your going to retire before 50 and especially in years where you just made more will balance other years where you make less or spend more.

2. If you don't have a PP then wherever you work you need to grab admin positions just as CMO or medical director spots. That's the only protection you have over admin replacing you with a few NPs to boost their income.

To be fair this applies to most non procedural fields with the threat of midlevels replacing them. Surgical specialties and rads are likely immune for the foreseeable future but then again they do a lot of things NPs can't quite do yet but that may change since NP scopes/stents are starting to be done years ago in certain academia places etc.

While I may not retire at 50, I only look at 3-5 years ahead at a time and thus have been doing all of the above. I also believe living like a resident (50k-60k gross spending) the first 5 years of attending life and investing every dime was key to getting me nearing some lower level FIRE numbers. I do rent in all fairness but i was told not to count your house towards these fire goals but that advice may be controversial and now that their may be some correction in prices I may look into that over the next 12 mo when housing prices bottom. Still adjusting to married life pushing my yearly spending slightly over 100k now lol.

I agree with a lot of this but taking a CMO/Medical Director spot is not the only protection, although it is one of. Other options include 1) leveraging efficiency to carry a higher patient load (if people don't think this happens, they are wrong - the average annual RVUs is much higher for psychiatrist than NPs in each of the systems I have worked, and they would need to hire 2 or sometimes even 3 midlevel providers to achieve the same coverage). This doesn't mean you do a bad job it means that because you did a residency and have additional experience, you are quicker at picking up patterns in clinical presentations, require less time to complete an intake, and are more quickly able to identify the correct treatment plan. 2) engagement in teaching and research may protect you in certain settings - clearly not in all but there are absolutely places where physicians are considered essential to sustain an academic mission. 3) you can contribute to quality outside of being a medical director through engagement in QI initiatives. 4) you can add value by leveraging any special knowledge you have to improve the care of a specific population or category of patients, and if this leads to improved outcomes such as lower readmissions, shorter lengths of stays, fewer workplace violence issues, less polypharmacy or any of the other metrics that are relevant to your system, you are less likely to be replaced.

 

[PikminOC]

I agree with a lot of this but taking a CMO/Medical Director spot is not the only protection, although it is one of. Other options include 1) leveraging efficiency to carry a higher patient load (if people don't think this happens, they are wrong - the average annual RVUs is much higher for psychiatrist than NPs in each of the systems I have worked, and they would need to hire 2 or sometimes even 3 midlevel providers to achieve the same coverage). This doesn't mean you do a bad job it means that because you did a residency and have additional experience, you are quicker at picking up patterns in clinical presentations, require less time to complete an intake, and are more quickly able to identify the correct treatment plan. 2) engagement in teaching and research may protect you in certain settings - clearly not in all but there are absolutely places where physicians are considered essential to sustain an academic mission. 3) you can contribute to quality outside of being a medical director through engagement in QI initiatives. 4) you can add value by leveraging any special knowledge you have to improve the care of a specific population or category of patients, and if this leads to improved outcomes such as lower readmissions, shorter lengths of stays, fewer workplace violence issues, less polypharmacy or any of the other metrics that are relevant to your system, you are less likely to be replaced.

You are a cog that can be replaced

 

[PikminOC]

Still on the graph it's not much of an increase since 1970 to 2019. Should be around 300 k to keep up with inflation.