Different practice settings in regards to quality of life/stress

[SeniorWrangler]

I did inpatient psych for a number of years and every year the working conditions got worse and the patients got sicker. I didn’t realize how burnt out I was until I left.

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[annoyedpsychiatrist]

I think I've gotten pretty lucky with my 1st gig out of residency. VA outpatient, 4 days a week only 1 in person and rest tele, typically 6-10 patients a day, 30 min f/u and 1 hour new, intakes are done already by a therapist on the team so new patients have a full history already written. Great support staff - therapists, social workers, pharmacy, etc. Very easy to refer patients to individual therapy, groups, rehab, residential, etc. I'm at an ancillary site so a lot of the complex patients get referred to the main VA academic site. Very little benzo seeking since these patients already know that VA docs generally will not prescribe them.

My work stress is extremely low. Sometimes I wonder if I should have taken one of the inpatient offers where I could make 350k+, but working from home with a light schedule is so cushy. I do have 2 weekend calls a year which are very easy w/ residents doing all the notes. I realized I'm also happier working with better functioning patients with depression, anxiety, PTSD, etc, rather than SMI.

My good friend in residency stayed in MCOL midwest metro and makes 75-100k more than me working inpatient w/ call, consults, supervising NPs, some outpatient for a community hospital. Obviously a great financial decision but he's not too happy with the job but sticking it out for a few years due to the contract incentives.

Also echo what Whopper said about state hospitals. I moonlighted at one in the midwest as a resident, and there were some attendings who worked hard and did a great job, and others who clearly didn't give a single **** and were there forever, probably doing 1-2 hours of bad work a day.

Wow, when i was in residency, the average patient load was 15 a day and most were in person and most were on benzos..and definitely not 30 minut f/us, was 20 minutes. I guess its really just location dependent. This sounds super chill

 

[Stagg737]

Curious as to why people hate C/L so much. Imo one of the lower stress areas as you're just a consultant and medical decisions are ultimately up to the primary team. If they don't like your recs, then that's on them. Even with assisting with social factors, still far lower responsibility for the situation than almost any other setting. Plus the medical aspect of mental health is also fascinating imo, I guess if people hate that it makes sense.

 

[comp1]

The stress with CL is that it's more complicated than them just not liking your recs and walking away. With CL, the other team IS the client. To some extent, your goal is to provide a service to them, not exactly the patient. It's a lot like child psych... Of course unlike patients and parents, other physicians tend to know exactly how to make a ruckus if they really don't like your recommendations. If they walk away, it tends to be loudly. Admittedly, it's much more of an issue when your facility has an attached inpatient psych unit where all medical and ED teams would like to place all dementia (and even delirium in a lot of cases). That said, yes, it does still beat outpatient by a lot for me. It still involves lots of support and teamwork.

 

[whopper]

Wrote this before-every CL gig I had the place gave several flippant requests for consults and the consult team had to waste about 15 minutes even up to 1 hour to get out of the BS consult. A major problem is doctors and nurses who ordered BS consults had no blowback if they ordered a frivolous consult. The psych attendings also frequently didn't give a $hit cause it was the residents who were thrown to the wolves with flippant consults so they usually did nothing. (My problem was I gave a $hit).

Someone did mention here that in their system their consult service was excellent. I also have another colleague telling me in his hospital it's great, but this is not the norm in teaching institutions. In both those places there were rules in place to prevent BS consults.

 

[Celexa]

Wrote this before-every CL gig I had the place gave several flippant requests for consults and the consult team had to waste about 15 minutes even up to 1 hour to get out of the BS consult. A major problem is doctors and nurses who ordered BS consults had no blowback if they ordered a frivolous consult. The psych attendings also frequently didn't give a $hit cause it was the residents who were thrown to the wolves with flippant consults so they usually did nothing. (My problem was I gave a $hit).

Someone did mention here that in their system their consult service was excellent. I also have another colleague telling me in his hospital it's great, but this is not the norm in teaching institutions. In both those places there were rules in place to prevent BS consults.

All hospitals have institutional personality disorders. When the hospital is your patient, boundaries are just as important as they are with individuals.....

 

[Stagg737]

The stress with CL is that it's more complicated than them just not liking your recs and walking away. With CL, the other team IS the client. To some extent, your goal is to provide a service to them, not exactly the patient. It's a lot like child psych... Of course unlike patients and parents, other physicians tend to know exactly how to make a ruckus if they really don't like your recommendations. If they walk away, it tends to be loudly. Admittedly, it's much more of an issue when your facility has an attached inpatient psych unit where all medical and ED teams would like to place all dementia (and even delirium in a lot of cases). That said, yes, it does still beat outpatient by a lot for me. It still involves lots of support and teamwork.

I'm part of a C/L team and cover the hospital when needed so well aware of some of the issues, including the inane meetings which are sometimes necessary. But like Celexa mentioned, a lot of this can be addressed by maintaining boundaries about what we can/will do and making sure those placing the consults are aware. Where I work has an inpatient psych unit but they are a completely separate team/division from the C/L team.

Wrote this before-every CL gig I had the place gave several flippant requests for consults and the consult team had to waste about 15 minutes even up to 1 hour to get out of the BS consult. A major problem is doctors and nurses who ordered BS consults had no blowback if they ordered a frivolous consult. The psych attendings also frequently didn't give a $hit cause it was the residents who were thrown to the wolves with flippant consults so they usually did nothing. (My problem was I gave a $hit).

Someone did mention here that in their system their consult service was excellent. I also have another colleague telling me in his hospital it's great, but this is not the norm in teaching institutions. In both those places there were rules in place to prevent BS consults.

I know you've written about it before, but my experience with consults has just been very different at a ~1,000 bed hospital. I stick with the same rule with the primary team as I do with patients, I shouldn't be doing more work than them. They want to dump a crappy consult, I'm happy to answer their basic question and they can feel free to reach out for clarification if needed. I am willing to do a lot of work, but only if the primary team is being engaged and reasonable.

Even with all of that, I still find it more enjoyable/lower stress than the ER where you may be completely screwed if a patient can't safely discharge and no one will take them.

 

[whopper]

I'm part of a C/L team and cover the hospital when needed so well aware of some of the issues, including the inane meetings which are sometimes necessary. But like Celexa mentioned, a lot of this can be addressed by maintaining boundaries about what we can/will do and making sure those placing the consults are aware. Where I work has an inpatient psych unit but they are a completely separate team/division from the C/L team.



I know you've written about it before, but my experience with consults has just been very different at a ~1,000 bed hospital. I stick with the same rule with the primary team as I do with patients, I shouldn't be doing more work than them. They want to dump a crappy consult, I'm happy to answer their basic question and they can feel free to reach out for clarification if needed. I am willing to do a lot of work, but only if the primary team is being engaged and reasonable.

Even with all of that, I still find it more enjoyable/lower stress than the ER where you may be completely screwed if a patient can't safely discharge and no one will take them.

While I worked at a state psych hospital we consulted IM. In those situations the IM doctor wasn't given BS consults but this was cause the only job of the IM doctor was to do consults and the doctor was on the unit most of the day. So the IM doctor could just ask the psychiatrist or head nurse what was going on.

Where as in a general hospital the typical psych consult was...."see patient" but there's no reason written. Or they'll write "depression" and you ask the patient what's going on and they claim they're not depressed. So you ask the nurse what's going on and she doesn't know and says the order was written before her shift. (Translation: I don't give a $hit. I don't know why it was ordered, and I'm not going to spend any time to try to find out why it was ordered even though it's my patient. I expect you to do all of this work). So then you beep the doctor who ordered it and he doesn't return the phone call for about 30 minutes. Then he finally gets back to you and he says something to the effect of "I don't know why this was ordered. The nurse on the shift said the patient was depressed so I just ordered it." You tell the doc that the current nurse doesn't know WTF is going on, she's not helping, the nurse that told you to order the consult isn't in the hospital and then he tells you to maybe you can drop this consult and to tell the head nurse to ask this prior nurse why it was called in the first place if she comes back on duty later in the day. So she comes on later in the day and doesn't know WTF is going on. All of this occurs in a span of 50 minutes of your time wasted and you only have 12 more consults to go, 8 of which will also be complete BS.

Or consult is for a "physiatrist" but the idiot who asked you to consult can't see that's what was written cause the doc had bad handwriting. So you spend about 50 minutes trying to find out why you're being asked to do a consult and it turned out it was for a physiatrist. Adding insult to injury, the idiots that wasted your time for the consult aren't apologetic at all, will suffer no repercussions for this waste of your time, don't care, and will continue doing it again and again and again.

Like I said before-demand to get paid by the consult. This way each time they throw a BS one at you, you'll be in the "yes sir, may I have another!?!?" attitude.

 

[untapped]

All hospitals have institutional personality disorders. When the hospital is your patient, boundaries are just as important as they are with individuals.....

This is why I didn't like C/L. The more I had to interact with people in academic medicine, the more burnt out I got. I think there's a level of toxicity in academic medicine that decreases the further away you get from the nidus. VA outpatient outside of the flagship location feels sufficiently far away, for now. I think at some point I'll probably try cash private practice, so that it's just me and the patients.

 

[Stagg737]

While I worked at a state psych hospital we consulted IM. In those situations the IM doctor wasn't given BS consults but this was cause the only job of the IM doctor was to do consults and the doctor was on the unit most of the day. So the IM doctor could just ask the psychiatrist or head nurse what was going on.

Where as in a general hospital the typical psych consult was...."see patient" but there's no reason written. Or they'll write "depression" and you ask the patient what's going on and they claim they're not depressed. So you ask the nurse what's going on and she doesn't know and says the order was written before her shift. (Translation: I don't give a $hit. I don't know why it was ordered, and I'm not going to spend any time to try to find out why it was ordered even though it's my patient. I expect you to do all of this work). So then you beep the doctor who ordered it and he doesn't return the phone call for about 30 minutes. Then he finally gets back to you and he says something to the effect of "I don't know why this was ordered. The nurse on the shift said the patient was depressed so I just ordered it." You tell the doc that the current nurse doesn't know WTF is going on, she's not helping, the nurse that told you to order the consult isn't in the hospital and then he tells you to maybe you can drop this consult and to tell the head nurse to ask this prior nurse why it was called in the first place if she comes back on duty later in the day. So she comes on later in the day and doesn't know WTF is going on. All of this occurs in a span of 50 minutes of your time wasted and you only have 12 more consults to go, 8 of which will also be complete BS.

Or consult is for a "physiatrist" but the idiot who asked you to consult can't see that's what was written cause the doc had bad handwriting. So you spend about 50 minutes trying to find out why you're being asked to do a consult and it turned out it was for a physiatrist. Adding insult to injury, the idiots that wasted your time for the consult aren't apologetic at all, will suffer no repercussions for this waste of your time, don't care, and will continue doing it again and again and again.

Like I said before-demand to get paid by the consult. This way each time they throw a BS one at you, you'll be in the "yes sir, may I have another!?!?" attitude.

Sounds like garbage hospitals/docs. I just send a message to the ordering doc or primary for the patient that I'll see them once they clarify wtf they want. I expect all consults sent to me from medicine to be a basic sentence like "capacity to leave AMA/refuse procedure" or "SI, assist with need for psych admission" and I let the ordering doc know that garbage like "depression" isn't going to cut it if they want our assistance. Maybe it's just a luxury of being at a large hospital where me not seeing the patient asap causes them more problems than it does for me, but the situation you're describing is something I wouldn't tolerate and am happy to discuss with admins when they ask why it's taking so long to see the patients or why the patients aren't being discharged once medically cleared.

 

[wolfvgang22]

Sounds like garbage hospitals/docs. I just send a message to the ordering doc or primary for the patient that I'll see them once they clarify wtf they want. I expect all consults sent to me from medicine to be a basic sentence like "capacity to leave AMA/refuse procedure" or "SI, assist with need for psych admission" and I let the ordering doc know that garbage like "depression" isn't going to cut it if they want our assistance. Maybe it's just a luxury of being at a large hospital where me not seeing the patient asap causes them more problems than it does for me, but the situation you're describing is something I wouldn't tolerate and am happy to discuss with admins when they ask why it's taking so long to see the patients or why the patients aren't being discharged once medically cleared.

I have a dot phrase in the EMR just for responding to vague C&L consult requests, complete with examples of what a reasonably complete request looks like.

 

[psychmd03]

This is so variable but personally for me I ripped through a variety of settings at one point I had 4 jobs out of residency one IP VA gig, an IP private hospital, IP sporadic coverage at a diff private hosptial and then some telepsych late night and weekend coverage. Then some Op later after dropping he tele psych gig and stopping the VA. For me the learning was discovering the most important part for me at this point is autonomy and being able to work around my life schedule rather than scheduling life around work. My patients are on the unit so I round when works best for me and neither job requires me to hang around the unit just be available by text or phone during the day. That allows me to remain very happy, have plenty of free time each day while leveraging really good teams to help everything be smooth. Plus the income is unable to be best my priorities might change in the future and I’ll maybe transition to a lazy VA job for the benefits but I’m young and I’d rather hustle now while these flexible jobs are available

 

[sloh]

This is so variable but personally for me I ripped through a variety of settings at one point I had 4 jobs out of residency one IP VA gig, an IP private hospital, IP sporadic coverage at a diff private hosptial and then some telepsych late night and weekend coverage. Then some Op later after dropping he tele psych gig and stopping the VA. For me the learning was discovering the most important part for me at this point is autonomy and being able to work around my life schedule rather than scheduling life around work. My patients are on the unit so I round when works best for me and neither job requires me to hang around the unit just be available by text or phone during the day. That allows me to remain very happy, have plenty of free time each day while leveraging really good teams to help everything be smooth. Plus the income is unable to be best my priorities might change in the future and I’ll maybe transition to a lazy VA job for the benefits but I’m young and I’d rather hustle now while these flexible jobs are available

And bc you work so few hrs per day, you can easily work almost every day

 

[psychmd03]

And bc you work so few hrs per day, you can easily work almost every day

Exactly. You’re not burnt out. And adding an extra day is a really good way to increase income. And if that “day” is 4-6 hrs but allows you to generate what most would in 8+ hours you will end up well ahead of your colleagues in income but also general happiness because you have much more free time. Do this early in your career to build your nest egg so it can start to grow itself

 

[wolfvgang22]

Exactly. You’re not burnt out. And adding an extra day is a really good way to increase income. And if that “day” is 4-6 hrs but allows you to generate what most would in 8+ hours you will end up well ahead of your colleagues in income but also general happiness because you have much more free time. Do this early in your career to build your nest egg so it can start to grow itself

Four questions if I may:
About how much is your annual income? Are you 1099 or W-2? Do you feel any stress with work calls and texts bleeding into your private time when you aren't at the hospital? Are you doing any night time call from home?

 

[psychmd03]

Four questions if I may:
About how much is your annual income? Are you 1099 or W-2? Do you feel any stress with work calls and texts bleeding into your private time when you aren't at the hospital? Are you doing any night time call from home?

A solid few standard deviations above psych docs. This year is gonna come down by 30-40% from last year but on purpose since last year I truly did too much and had to slow down. I currently have settled on one w2 and one 1099. They both end up generating mid 6 figures. The w2 I can generate more if I am over my cap so I generally see more if it ends up being helpful to others rather than some of the docs I work with that throw fits about it. The 1099 of course is fully dependent on my work volume. I bill insurance directly for that job and have a med director stipend. I have trained my teams to text which I do not feel is intrusive and I respond quickly even at times when nursing can’t get other docs just to be helpful. It’s always good to have all the support staff like you. Phone calls I find very intrusive luckily I don’t get many at all. I don’t do any nighttime call the w2 hospital will contact me up to about 9-10pm then maybe an overnight text that they don’t expect a response until the am if one is needed at all

 

[psychemdoc]

A solid few standard deviations above psych docs. This year is gonna come down by 30-40% from last year but on purpose since last year I truly did too much and had to slow down. I currently have settled on one w2 and one 1099. They both end up generating mid 6 figures. The w2 I can generate more if I am over my cap so I generally see more if it ends up being helpful to others rather than some of the docs I work with that throw fits about it. The 1099 of course is fully dependent on my work volume. I bill insurance directly for that job and have a med director stipend. I have trained my teams to text which I do not feel is intrusive and I respond quickly even at times when nursing can’t get other docs just to be helpful. It’s always good to have all the support staff like you. Phone calls I find very intrusive luckily I don’t get many at all. I don’t do any nighttime call the w2 hospital will contact me up to about 9-10pm then maybe an overnight text that they don’t expect a response until the am if one is needed at all

Wait what? How? Can you either explain this magic trick Houdini or just skip that and adopt me? You’re in upper 6 figures after a 30-40% pay cut? That’s pretty incredible for just a psychiatrist. Anything special/unique that helps you get these opportunities like fellowships or is this just a ton of hours or location-dependent or what exactly? Not a lot of psychiatrists out there are anywhere close to this.

 

[forchinet121]

Wait what? How? Can you either explain this magic trick Houdini or just skip that and adopt me? You’re in upper 6 figures after a 30-40% pay cut? That’s pretty incredible for just a psychiatrist. Anything special/unique that helps you get these opportunities like fellowships or is this just a ton of hours or location-dependent or what exactly? Not a lot of psychiatrists out there are anywhere close to this.

He sees like 60 patients a day

 

[psychmd03]

Wait what? How? Can you either explain this magic trick Houdini or just skip that and adopt me? You’re in upper 6 figures after a 30-40% pay cut? That’s pretty incredible for just a psychiatrist. Anything special/unique that helps you get these opportunities like fellowships or is this just a ton of hours or location-dependent or what exactly? Not a lot of psychiatrists out there are anywhere close to this.

The how was working more than most would want or be able to. I worked 7 days a week taking off 2 days every few months only and worked more hours than I do now. It was nowhere near balanced. So sure people will say OMG not possible, you cant do that etc. But, again a lot of people could but they just aren't willing to make some sacrifices. Honestly, I am not anymore either but a year and a half of heavy heavy work shot me foward to building a nest egg that will grow it self and allow for much more freedom of choice very early in my career. As for how I got the jobs one was a moonlighting job that a friend got me into when he was on his way out and they recruited me hard. I pushed back really hard not wanting the job but that made them fight to get me more so I know have a scribe they pay for they admit me the psychotic heavily manic very sick patients I like, if I do extra coverage I get paid for that plus I get a scribe for those patients too. I have an admin stipend as well at that job. The other was networking from my biller which then turned into a small trial run of coverage and the teams I worked with liked me so the department head gave me work. Word of mouth got me a lot more coverage from the other docs. And that same word of mouth got me a lot of opportunities that I have finally learned to say no to so I don't slide back into working too much. No fellow ships just some networking and then getting in and doing a good job, play nice with others and then see where that takes you. I for sure consider myself lucky which is another reason I have run so hard with it who knows when that clock runs out. The 1099 hospital has been bought out three times since I have been there which is only 3 years lol.

 

[psychmd03]

He sees like 60 patients a day

The key is volume while also doing a good job. Having the entire team of SW, nursing, techs, patients as well as c suite all agree you do a good job. Don't run up a complaint list because you don't do you job, dont care for your patients or dont listen to your team. Do a job that top to bottom everybody recognizes as good and then watch the opportunities come.

 

[psychemdoc]

The how was working more than most would want or be able to. I worked 7 days a week taking off 2 days every few months only and worked more hours than I do now. It was nowhere near balanced. So sure people will say OMG not possible, you cant do that etc. But, again a lot of people could but they just aren't willing to make some sacrifices. Honestly, I am not anymore either but a year and a half of heavy heavy work shot me foward to building a nest egg that will grow it self and allow for much more freedom of choice very early in my career. As for how I got the jobs one was a moonlighting job that a friend got me into when he was on his way out and they recruited me hard. I pushed back really hard not wanting the job but that made them fight to get me more so I know have a scribe they pay for they admit me the psychotic heavily manic very sick patients I like, if I do extra coverage I get paid for that plus I get a scribe for those patients too. I have an admin stipend as well at that job. The other was networking from my biller which then turned into a small trial run of coverage and the teams I worked with liked me so the department head gave me work. Word of mouth got me a lot more coverage from the other docs. And that same word of mouth got me a lot of opportunities that I have finally learned to say no to so I don't slide back into working too much. No fellow ships just some networking and then getting in and doing a good job, play nice with others and then see where that takes you. I for sure consider myself lucky which is another reason I have run so hard with it who knows when that clock runs out. The 1099 hospital has been bought out three times since I have been there which is only 3 years lol.

That’s incredible. And do you feel like this truly replicable in a lot of areas across the country or just certain markets if people are willing to really grind? How many hours a week would you say you were working before and now?

 

[psychmd03]

That’s incredible. And do you feel like this truly replicable in a lot of areas across the country or just certain markets if people are willing to really grind? How many hours a week would you say you were working before and now?

That’s a good question I don’t want to just randomly say things without backing so I’ll just say my guess is you’d need an area that has multiple IP units private stand alones have probably a better likelihood of letting you barter for what you want in flexible schedules etc. and then yes be willing to work and output top notch work. I was a little above 60hrs or so mostly which for me is a lot I don’t like it.

 

[sloh]

This is so variable but personally for me I ripped through a variety of settings at one point I had 4 jobs out of residency one IP VA gig, an IP private hospital, IP sporadic coverage at a diff private hosptial and then some telepsych late night and weekend coverage. Then some Op later after dropping he tele psych gig and stopping the VA. For me the learning was discovering the most important part for me at this point is autonomy and being able to work around my life schedule rather than scheduling life around work. My patients are on the unit so I round when works best for me and neither job requires me to hang around the unit just be available by text or phone during the day. That allows me to remain very happy, have plenty of free time each day while leveraging really good teams to help everything be smooth. Plus the income is unable to be best my priorities might change in the future and I’ll maybe transition to a lazy VA job for the benefits but I’m young and I’d rather hustle now while these flexible jobs are available

Really love your input here man. Can you expand on your experiences with the tele gig?

 

[Stagg737]

That’s incredible. And do you feel like this truly replicable in a lot of areas across the country or just certain markets if people are willing to really grind? How many hours a week would you say you were working before and now?

I mean, if you're willing to be a work horse you can cobble together multiple jobs and make bank. Not everyone can see the volume that the poster sees in 60 hours per week and I still question what their definition of "good care" is given the stated volume (I've talked to staff at hospitals where they thought they were doing a good job and it was pretty bad). Almost no one wants to work a schedule where they take off <2 days per month. For comparison, I work in an academic setting where I average seeing about 5-6 patients a day (standard time spent with them), call is Q6 weekends with extra pay for call days, and I'll gross around $250k this year. One of my colleagues who is about as efficient as the poster you're referring to (but sees much smaller volume) will gross around $600k this year in an academic setting.

Psychmd03 sounds like they've got a pretty good set up financially that they've capitalized on. While you may not be able to pull in those numbers, it's not hard to hit well above $500k or even upper six figures if you put together multiple jobs, are willing to work and be flexible with your own time, and know how to negotiate decently. Many of us don't do this because we don't want to, not because we can't.

 

[calvnandhobbs68]

I mean, if you're willing to be a work horse you can cobble together multiple jobs and make bank. Not everyone can see the volume that the poster sees in 60 hours per week and I still question what their definition of "good care" is given the stated volume (I've talked to staff at hospitals where they thought they were doing a good job and it was pretty bad). Almost no one wants to work a schedule where they take off <2 days per month. For comparison, I work in an academic setting where I average seeing about 5-6 patients a day (standard time spent with them), call is Q6 weekends with extra pay for call days, and I'll gross around $250k this year. One of my colleagues who is about as efficient as the poster you're referring to (but sees much smaller volume) will gross around $600k this year in an academic setting.

Psychmd03 sounds like they've got a pretty good set up financially that they've capitalized on. While you may not be able to pull in those numbers, it's not hard to hit well above $500k or even upper six figures if you put together multiple jobs, are willing to work and be flexible with your own time, and know how to negotiate decently. Many of us don't do this because we don't want to, not because we can't.

Right the vast majority of psychiatrists don't want to work 60 hours a week and see 60 patients a day. If one does want to do that, you can make a lot of money.

 

[psychmd03]

Really love your input here man. Can you expand on your experiences with the tele gig?

Thank you. So it was a prn gig that you sign up for shifts 4-12 hr chunks and a certain number of hours a month had to be nights and weekends because I was on the lowest end of their jobs available basically the most flexible and lowest number of hours needed. I covered random hospitals their ED and medical floor consults. There was a tiny hourly stipend to be available and the main money was made on a per consult basis. I believe it was $150 a consult. I ended up learning when though this could be very flexible it was still driving me nuts thinking I had to be tied near my computer it just took away full freedom nights and larger chunks of weekends then what I can do if I do in person visits. So I ended up dropping it fast. They did apply and pay for 3 state licenses they also did all the hospital credentialing.

I mean, if you're willing to be a work horse you can cobble together multiple jobs and make bank. Not everyone can see the volume that the poster sees in 60 hours per week and I still question what their definition of "good care" is given the stated volume (I've talked to staff at hospitals where they thought they were doing a good job and it was pretty bad). Almost no one wants to work a schedule where they take off <2 days per month. For comparison, I work in an academic setting where I average seeing about 5-6 patients a day (standard time spent with them), call is Q6 weekends with extra pay for call days, and I'll gross around $250k this year. One of my colleagues who is about as efficient as the poster you're referring to (but sees much smaller volume) will gross around $600k this year in an academic setting.

Psychmd03 sounds like they've got a pretty good set up financially that they've capitalized on. While you may not be able to pull in those numbers, it's not hard to hit well above $500k or even upper six figures if you put together multiple jobs, are willing to work and be flexible with your own time, and know how to negotiate decently. Many of us don't do this because we don't want to, not because we can't.

I would generally agree. I see people that see way less still give crap care and I have their patients come up to me and ask to switch docs. And truthfully no one really wants to put that level of work in. It’s a big sacrifice but I would do it again just because of how quickly it launched my financial life forward. Luckily I have no kids so it’s easy for me to really invest in myself. I fully agree also that there isn’t really a need to shoot so high and that mid 6 figures is doable for many psych docs if that’s what they’d like. Not every system will have the opportunity but many can.

Right the vast majority of psychiatrists don't want to work 60 hours a week and see 60 patients a day. If one does want to do that, you can make a lot of money.

100% true. And 60 hours is not fun. It’s a sprint meant to be done for a short period of time to really leap forward.

 

[sloh]

It’s a big sacrifice but I would do it again just because of how quickly it launched my financial life forward. Luckily I have no kids so it’s easy for me to really invest in myself. I fully agree also that there isn’t really a need to shoot so high and that mid 6 figures is doable for many psych docs if that’s what they’d like. Not every system will have the opportunity but many can.



100% true. And 60 hours is not fun. It’s a sprint meant to be done for a short period of time to really leap forward.

Yup totally worth the hustle. I imagine you’ve already cleared 1 million in investable assets by now and that’s really the threshold where compounding takes off. You can scale back and cruise now. The subsequent millions will come much faster.

 

[sloh]

Oops duplicate post

 

[psychmd03]

Yup totally worth the hustle. I imagine you’ve already cleared 1 million in investable assets by now and that’s really the threshold where compounding takes off. You can scale back and cruise now. The subsequent millions will come much faster.

This is a great point hopefully people can internalize the idea being highlighted. Once you build that nest egg it can really start to significantly grow itself. So it becomes easier to build wealth once you have a solid base. Compounding in your investment portfolio really takes off.

 

[forchinet121]

This is a great point hopefully people can internalize the idea being highlighted. Once you build that nest egg it can really start to significantly grow itself. So it becomes easier to build wealth once you have a solid base. Compounding in your investment portfolio really takes off.

Most psychiatrists can’t or won’t see as many as you do in a day so they will never make as much money as you do ever

 

[psychmd03]

Most psychiatrists can’t or won’t see as many as you do in a day so they will never make as much money as you do ever

Agreed most won’t but that doesn’t mean many do have the ability to generate more than it might seem at the surface. Especially when you are first coming out and you have the most time and energy as well as the most debt and negative net worth.

 

[Attending1985]

5 years. Many doctors work at the VA for the last 5 years of their career, because this enables you to get FEHB (federal health insurance) for life at the same rate you would pay as an employee. Federal insurance options include about 7 insurance companies that each have 4 to 6 types of plans available. Blue Cross, Cigna, United, GEHA, APWU, just to name a few.

Is that a retirement benefit or could you take it with you after five years at any time?

 

[comp1]

The poster said the doctors work for the last five years of their career because you have to be eligible for retirement to get federal health insurance and benefits in retirement. If you just quit the VA after five years, but weren't eligible to retire...you don't get to keep the benefits. Retirement means more than quitting the job. For federal employment, it means meeting a combination of being the minimum retirement age and having enough creditable service years. To retire at 57, you need 30 years of federal employment. To retire at 60, 20 years and to retire at 62 you only need five years of creditable employment. Of course there are many financial benefits to continuing to work past 62 and hopefully doctors stick around a lot longer than five years in general.

 

[Attending1985]

The poster said the doctors work for the last five years of their career because you have to be eligible for retirement to get federal health insurance and benefits in retirement. If you just quit the VA after five years, but weren't eligible to retire...you don't get to keep the benefits. Retirement means more than quitting the job. For federal employment, it means meeting a combination of being the minimum retirement age and having enough creditable service years. To retire at 57, you need 30 years of federal employment. To retire at 60, 20 years and to retire at 62 you only need five years of creditable employment. Of course there are many financial benefits to continuing to work past 62 and hopefully doctors stick around a lot longer than five years in general.

Thanks for clarifying. I’m turning 40 next year maybe it’s time to apply to the Va so I can retire at 60.

 

[G Sheb]

I don't think there's any setting that is significantly less stressful.
You're carrying pretty high risk, whether it's in the ER, outpatient or inpatient. You could argue private practice, since people tend to pick and chose who they want to work with (not sure it's a great practice when you just pick 'easy patients' or those you get along with), but it's hard to avoid seriously narcissistic patients and those with $$$ can actually go after you and sue you. I've certainly heard stories of embittered patients who would go that route if you happened to cross them in one way or another. There are also plenty of high functioning, wealthy patients who are a serious suicide risk.

I find that moonlighting work tends to be easier as the responsibilities are frankly less.
But the real antidote to burnout is being engaged in what you are doing, whatever it is.
For me, working shifts that are spaced across the month is a good way of dealing with the stress of the job.

 

[calvnandhobbs68]

I don't think there's any setting that is significantly less stressful.
You're carrying pretty high risk, whether it's in the ER, outpatient or inpatient. You could argue private practice, since people tend to pick and chose who they want to work with (not sure it's a great practice when you just pick 'easy patients' or those you get along with), but it's hard to avoid seriously narcissistic patients and those with $$$ can actually go after you and sue you. I've certainly heard stories of embittered patients who would go that route if you happened to cross them in one way or another. There are also plenty of high functioning, wealthy patients who are a serious suicide risk.

This is just objectively not true for the 5th time or however many times it's been. Psychiatry is one of the lowest risk lawsuit specialities. You are objectively less likely to be sued than most other specialities. So relatively it should actually be less stress than say family medicine in terms of "risk". Relative to outpatient, inpatient and ER are probably higher risk in terms of bad outcomes but all of these are lower risk than almost any other medical speciality.

 

[G Sheb]

This is just objectively not true for the 5th time or however many times it's been. Psychiatry is one of the lowest risk lawsuit specialities. You are objectively less likely to be sued than most other specialities. So relatively it should actually be less stress than say family medicine in terms of "risk". Relative to outpatient, inpatient and ER are probably higher risk in terms of bad outcomes but all of these are lower risk than almost any other medical speciality.

I'm not comparing psychiatry to other medical specialties. Fix your reading comprehension.
Risk is also not just about getting sued. Making life/death decisions is stressful.

 

[calvnandhobbs68]

I'm not comparing psychiatry to other medical specialties. Fix your reading comprehension.
Risk is also not just about getting sued. Making life/death decisions is stressful.

Missed the part where you seem to be comparing psychiatry to anything.

The only risk you mentioned in that post was being sued (which was addressed) and suicide risk. Suicide is still such a statistically rare event that we do terribly in terms of predicting short term suicide risk. So yes I suppose it could be stressful if you had the fantasy that you can somehow meaningfully predict and mitigate immediate suicide risk reliably.