How does one go about making a lot of money in psychiatry? Do specializations like Pain Medicine or Child Psych increase income a lot? If so, which one pays more?
What is your definition of big money?
Lots of psychiatrists make >300k. Psych is one of the few fields where it is quite possible to not accept insurance and charge "what the market will bear". It's not unheard of for psychiatrists in some markets (NYC, San Francisco, LA) to charge close to $500/hr. This is not the norm of course. But there are many psychiatrists in most big cities that charge in the $200+/hr range, and with very little overhead and a 40 hours work week this is more than $300k/yr net.like money equivalent to what a urologist makes (>300,000)
Would love to hear if any current attendings or senior residents have further thoughts.
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some ways of making $$$ as a psychiatrist:
1. sleep medicine
2. clinical trials
3. drug-company speaker
4. as others have mentioned, have wealthy patients and don't take insurance.
like money equivalent to what a urologist makes (>300,000)
some ways of making $$$ as a psychiatrist:
3. drug-company speaker
.
like money equivalent to what a urologist makes (>300,000)
How much approximately? I have heard in the range of $1500/talk - but thats when you go on a "tour" and give about 3 talks in the week. The math comes about the same as the income one can make if they see 10 patients a day, no?
How so? Doing trials for pharm companies?
Most reasonable insurance companies are willing to pay between $50 - $70 for a visit. I'm surprised that no one has mentioned that they turn their practice into a Suboxone Factory (100 person max after the first year at 30).
Most reasonable insurance companies are willing to pay between $50 - $70 for a visit. I'm surprised that no one has mentioned that they turn their practice into a Suboxone Factory (100 person max after the first year at 30).
doesn't care what I think about soul-selling anyway...
Wait - you can get money for that too?
I suppose a guy could do this by day, do drug talks by night, and make a killing...but ....oh well...anyone interested in that life doesn't care what I think about soul-selling anyway...
If you aren't running a profitable business then you have failed. And that's when you run to the government and beg and grovel for their scraps and the delayment of medicare cuts or advancement of maobama's agenda. It is always the primary goal whether you want to admit it or not. Some people choose to neglect the pursuit of it, but it is firmly fixed as the primary goal for everyone.
If you aren't running a profitable business then you have failed. And that's when you run to the government and beg and grovel for their scraps and the delayment of medicare cuts or advancement of maobama's agenda. It is always the primary goal whether you want to admit it or not. Some people choose to neglect the pursuit of it, but it is firmly fixed as the primary goal for everyone.
Sorry it has taken me so long to reply, had to clean the vomit off of myself first.
Your posts smack of Randian Objectivism, which I loathe with a passion only slightly less than that I hold for socialism in all its many forms. Mostly because it is a juvenile and *****ic caricature of the doctrine of self interest.
I've been a free market supporter and armchair libertarian philosopher for years. I've been mentioned positively in the National Review no less than three times. Not sure how I feel about that honestly lol. I also have been flying the Gadsden flag years before it became re-popularized by the tea party.
As a reasoned and reasoning individual with a background in theory of science, game theory and mathematical modeling, I learned long ago that a model is only as good as its assumptions. Free market and limited government theories of governance, economics, and association enjoy assumptions that are much more robust than those of central planning/socialism. Self interest is after all the guiding principle of all life on earth.
However, where things start to fall apart is when one looks at the conditions necessary for a perfect market. None of them apply to medicine and healthcare. A free market is thus going to be determinstically inefficient in both quality and efficiency of healthcare products and services.
This isn't to say that market-based solutions aren't preferred. And I have blogged and written fairly extensively on how the healthcare market could benefit from being made more free. As well as how a better understanding and protection against the phenomena of game theoretic traps such as the commons, moral hazard, and discounting the future can improve efficiency beyond a purely free market and far, far beyond a single-payer/employer-based/government health insurance system while still engendering the maximum amount of freedom, quality, and efficiency.
Again, the free market isn't the be all and end all but a recognition of the primacy of self interest in the determination of our behavior.
And it is on the point of self interest that your comments show themselves to be so shallow. If profitability and profits are your primary goal, you have already failed by going into medicine. The opportunity cost of the years of training, the lost wages, the loss of years of investment in the market and your own enterprise compared to other, more profit-centered ways of doing business, is nearly impossible to recoup, with the possible exception of that spine doc at Wash U who bills for nearly 2 million a year.
Self interest is a pervasive principle that is poorly understood by the market worshipers who also fail to recognize its breadth: Income is not the only thing valued by the individual. If it was, the Laffer Curve wouldn't exist. Individuals value their families, their leisure time, their personal satisfaction, and their value systems. They value art, and entertainment, and the taste of good food. And they are willing to forego income to enjoy these less tangible goods.
And on to ethics. Because of the inherent asymmetries of the healthcare market, the most profitable business model for the physician will almost definitely not be the most ethical. Neither will it be the one that provides the greatest good to our patients. This is because of the limits of rationality and information asymmetry. And this is because in an imperfect market, profits are determined not by simple supply and demand, but by the ability to leverage the inefficiency in one's own favor. In the case of healthcare, this means trading on the irrationality of patients, the low value they place on intrinsic health, and their limited information when compared to the advantage of the decade-plus investment in acquiring information the doctor enjoys comparatively.
Psychotherapy will have a lower profit margin than med checks, procedures a higher profit margin than intensive rehabilitation, and the quick, easy, sexy fixes that trade on the irrationality and limited information of patients will be the surest way to make a lot of money.
Medicine would devolve into a system in which we deliver the most amount of care possible, at high rates of inefficiency, with little regard to long-term impact on patient health, agency, and quality of life. The fact that patients place little import on intrinsic health is seen in the rising rates of chronic disease, the poor effort placed on lifestyle intervention by physician and patient alike, and the atrocious lack of emphasis patients place on rehabilitation, preferring instead to slowly decay or acquiesce to disease. We also see this in how many patients insist that dilaudid is the only thing that helps their pain, confusing dissocation and the pleasurable sensation of getting high to pain relief. The most profitable practice of medicine would trade on this, and exploit the flawed lack of value placed on intrinsic health by our patients' own self interested desire for a minimum of effort and a maximum of comfort. Patients don't pay based on an expectation of health so much as they do based on a desire for comfort.
As a freelance author, I guarantee you I would be able to sell more articles if I wrote about how the fanciest formulations of sports supplements taken in absurd doses are better, or wrote "Put 2 inches on your arms. In three weeks!!!!" I value truth and integrity more. So I write fewer articles and spend more time on them. I have never been paid to support a single product, and when I do support one, it is because I myself have researched it extensively and use it myself, without a sponsorship or subsidy. And haven't even tried to sell to the highest bidding magazines. I guess I'm a failure.
As a future interventional pain physician, I'm pretty sure I would make more money by doing nothing but endless ESIs and TPIs, making my patients beholden to me for regular visits to bring them relief, and doing 15 minute med checks titrating their opioids endlessly upwards, instead of a comprehensive approach involving psychodynamic and cognitive-behavioral therapy along with a strong focus on rehab in addition to prudent intervention acting in synergy with the other techniques as I plan to. And to make it worse, I want to find a way to help people that can't pay full fees in cash!!! I guess I'm going to be a failure as a physician as well.
Somehow, though I might fail to turn myself into a prostitute with the ethics of a congressman, I think I'll still manage to be profitable and make an excellent income. Don't worry, I want an end to government healthcare in all its forms (which IMO includes employer-coupled health insurance), believe me I do. But I'm pretty sure that I can make some decent money, run a profitable practice, and still manage to serve my patients' needs without losing my morality and my soul in the process.
So let me repeat myself. I think profitability and sustainability are important goals. I think free market solutions to healthcare are imperative. But if you try to run the most profitable practice possible, you will not be running one in which patients' health even resembles a focus.
The priesthood is a calling. Medicine is a profession.The dedication and service it takes to be good at your job precludes medicine from simply being a profession. It's a calling.
The priesthood is a calling. Medicine is a profession.
Many fields require a lot of dedication and service to be good at your job. Let's not pat ourselves so hard on the back that we choke.
I agree that keeping firmly in mind that we are in the business of health rather than focusing on the bottom line is important or vital, but the "it's a calling" thing gets tired... We don't all need MD license plates and tee-shirts...
Yeah. "It's a calling" because it's a guaranteed six-figure job with relative autonomy, prestige, and unparalleled job security. Funny how that works.
i didnt read this, i just want to know can we get back on topic about making big $$$$$$
If you aren't running a profitable business then you have failed.
It is extremely rare for CL services to make a profit of any description...
You CL folks make a lot of profit for the hospital! Consult psychiatrists make a lot of money (and improve patient care immensely) by putting out fires (via training and educating staff) and assisting with disposition (and freeing up beds that are gonna make a lot more money for the hospital than the delirious guy sitting there for the 23rd day) and many other ways that you could describe much better than me.
It actually amazes me that hospitals are forward-thinking enough to realize that having a poorly-reimbursed service actually improves their bottom line and patient care.
You CL folks make a lot of profit for the hospital! Consult psychiatrists make a lot of money (and improve patient care immensely) by putting out fires (via training and educating staff) and assisting with disposition (and freeing up beds that are gonna make a lot more money for the hospital than the delirious guy sitting there for the 23rd day) and many other ways that you could describe much better than me.
It actually amazes me that hospitals are forward-thinking enough to realize that having a poorly-reimbursed service actually improves their bottom line and patient care.
If a psychiatrist only wanted to do ECT and focus on calibrating vagal nerve stimulators or just suboxone or whatever niche you can think of, so what? There is nothing wrong with that (as long as the treatment is warranted). .
I'm not advocating a physician step outside the physician duty of offering the best and most appropriate care for their patient. This I felt was a safe assumption, but some felt my belief in pursuing money effeciently would denigrate to poor medicine.
People can cross the line into poor medicine and make a greater profit. Yes, this is true, but I'm not advocating that.
Even in employed positions like C&L psych, you still have a value and a worth. To not know what your salary and profitability is means a greater profit for your employer. Hospitalists know their worth and adequately get their subsidies. Same thing applies for C&L. The down side is your only real bargaining chip with these positions is quitting. No thanks, not for me.
Outpatient docs can choose their insurance plans carefully. Maximize their office IT. Or even go cash only. For instance, Neurosurgeons will walk away from hospitals and trauma call to focus on spine. That isn't bad medicine but focusing on good medicine for the patients they do see. Their reasons for not taking call or doing trauma is the fault of the hospital, government, and society as a whole. If a psychiatrist only wanted to do ECT and focus on calibrating vagal nerve stimulators or just suboxone or whatever niche you can think of, so what? There is nothing wrong with that (as long as the treatment is warranted). If certain treaments all of a sudden have no one to do them then the system needs to change or patients need to pay up. Patients want a psychiatrist to also do therapy, well the system should pay more, or the patients should pay for it (some do).
As for the idea of all hospitals becoming like geisner, kaiser, etc. Hell no! That is essentially resigning all your rights as a physician to a suit. They are the reasons many physicians hate medicine in the first place. Why people walk right into the heart of lions den baffles me. You as a psychologist I can understand the allure. Those are the systems that often look to circumvent physicians and give more power to allied practitioners in hopes of maximizing their profit. I have no desire to be employee who needs to jump through hoops to earn a bonus biscuit. I aim to be a professional who is sought out by patients and paid accordingly and all the "bonus money" already goes to me. No thanks, you can keep McHealthCare.
I'm focused on the patient and eventually making sure I'm paid for what I'm worth - and not letting some parasite steal my money. Whether that parasite is an insurance company, goverment insurance, employed status, poor office structure, horrible IT, poor bedside manner, etc. I aim to avoid it.
The priesthood is a calling. Medicine is a profession.
Many fields require a lot of dedication and service to be good at your job. Let's not pat ourselves so hard on the back that we choke.
I agree that keeping firmly in mind that we are in the business of health rather than focusing on the bottom line is important or vital, but the "it's a calling" thing gets tired... We don't all need MD license plates and tee-shirts...
Very true. Of course, the same is true of my mechanic, at least when he's dealing with slobs like me. But I doubt he'd gaze into the distance and talk about his calling.Using the language of behavioral ecology, medicine lies outside the market by virtue of the amazing information asymmetry between physician and patient. The power differential is huge, and must be respected.
Very true. Of course, the same is true of my mechanic, at least when he's dealing with slobs like me. But I doubt he'd gaze into the distance and talk about his calling.