psychiatry salary

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michaelrack said:
"I don't really care how you get there. If you grow your business you get more money".

It matters how you get there. There are only so many hours in a day. A business based on a doc working 100 hrs a week isn't sustainable.
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I never said one doc would work 100 hours per week. You can hire more docs, more mid levels. There 1000 ways to grow a practice. But I didn't come here to debate this.

My only point is that a business minded psychiatrist will also have access to new revenue streams after a few years of practice. Different ones than an ophtho, sure, but money is money...at least to me. I really don't care whether it came from my 3 employed psychiatrists and 3 mid levels plus other business ventures, or if it came from the fees for a surgical center. It all goes to the same place.

Things we can get into that ophtho can't: therapists, suboxone, addictions treatment for the rich (horse farm near me charges 30k/mo per pt), private schools for rich kids with developmental problems/autism, telepsychiatry...the list goes on.
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Double post. Stupid app error...
 
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digitlnoize said:
My only point is that a business minded psychiatrist will also have access to new revenue streams after a few years of practice. Different ones than an ophtho, sure, but money is money...at least to me. I really don't care whether it came from my 3 employed psychiatrists and 3 mid levels plus other business ventures, or if it came from the fees for a surgical center. It all goes to the same place.

Things we can get into that ophtho can't: therapists, suboxone, addictions treatment for the rich (horse farm near me charges 30k/mo per pt), private schools for rich kids with developmental problems/autism, telepsychiatry...the list goes on.
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Fair enough. I agree with your main point.

Multiple streams of revenue are great. It's fine to have high income sources of revenue that depend on your own personal involvement (for me it is reading sleep studies, for a non-sleep psychiatrist it may be suboxone, addictions tx for the rich, etc).
Leveraging your time by hiring NP's is also a good idea, as is hiring other psychiatrists (which may require only minimal time on your part to supervise).
The ideal situation is to develop some sources of income that occur while you are asleep (i.e., don't require your personal ongoing involvement)- included in this would be your example of renting out a building.

I am sure someone is going to slam me for this, but if you haven't read Rich Dad, Poor Dad; you may find this book interesting. Although vague on practical details, this book does lay out a useful philosophy for generating income.

A disclaimer for members of the general public reading this: I am only a businessman outside the exam room. Financial issues are not involved when I am seeing individual patients.
 
I like this thread. I like talking business....


However, I feel like its worthwhile to point out the fact that most of these things we use to stretch our income will not significantly enhance our quality of life. I am now convinced that being "rich" has just as many problems as living in poverty. You may not be fat, ghetto, and lack access to decent healthcare but you'd just might be worried, suffer from the greedies, and afraid to lose all that you think you have.

I'm very fortunate to have grown up dirt poor. 200K is definitely enough to enjoy myself. And unless inflation takes the shoes off of our feet it'll be enough to put my offspring in a position to earn their own 200K. I guess I'm a "Poor Mom" but I'm also fairly happy about the way my life turned out....


*Off of my soapbox and back to our regularly scheduled commentary*
 
Hiring staff and mid-levels to setup a large medical practice seems like it would be a lot of work and responsibility ie. advertising for the positions, setting up interview dates, taking interviewers out to lunch, drawing up a contract, negotiating a deal, setting up payroll, deciding on part-time vs. full-time, designating benefits (health, dental, vision), deciding whether or not to offer malpractice, figuring out their PTO, dealing with grievances, etc. Also, the thought of having oversight over thousands of patients and having a higher incidence of medical-legal issues sounds terrifying :scared:

I have noticed a good number of entrepreneurial MDs, RNs and Social workers that setup Psychiatric facilities and hire Psychiatrists, Psychologists and other staff. I do not know how they do it...:confused:
 
F0nzie said:
Hiring staff and mid-levels to setup a large medical practice seems like it would be a lot of work and responsibility ie. advertising for the positions, setting up interview dates, taking interviewers out to lunch, drawing up a contract, negotiating a deal, setting up payroll, deciding on part-time vs. full-time, designating benefits (health, dental, vision), deciding whether or not to offer malpractice, figuring out their PTO, dealing with grievances, etc. Also, the thought of having oversight over thousands of patients and having a higher incidence of medical-legal issues sounds terrifying :scared:

I have noticed a good number of entrepreneurial MDs, RNs and Social workers that setup Psychiatric facilities and hire Psychiatrists, Psychologists and other staff. I do not know how they do it...:confused:
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you have to be business minded coming into med school

before i started med school i used to run my parent's psych clinics

don't want to give too many details because my parents read these forums and they don't want me to disclose too many details
 
PrideNeverDie said:
you have to be business minded coming into med school

before i started med school i used to run my parent's psych clinics

don't want to give too many details because my parents read these forums and they don't want me to disclose too many details
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Even if you released your parents step-by-step guide, 99% of the psychiatrists on here won't follow it because it's too much work. It's far more desirable to get paid by the hour seeing patients than learning how to enter data in Quickbooks. I think your parents might be a bit paranoid over losing revenue from posting their "secrets" on SDN.
 
F0nzie said:
Hiring staff and mid-levels to setup a large medical practice seems like it would be a lot of work and responsibility ie. advertising for the positions, setting up interview dates, taking interviewers out to lunch, drawing up a contract, negotiating a deal, setting up payroll, deciding on part-time vs. full-time, designating benefits (health, dental, vision), deciding whether or not to offer malpractice, figuring out their PTO, dealing with grievances, etc. Also, the thought of having oversight over thousands of patients and having a higher incidence of medical-legal issues sounds terrifying :scared:
:
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It is a lot of work, especially if you do it all at once. Probably most docs who do this either 1) do it gradually- start off solo and then add an NP and gradually add more staff or 2) leave another group and copy what that group did
 
digitlnoize said:
I never said one doc would work 100 hours per week. You can hire more docs, more mid levels. There 1000 ways to grow a practice. But I didn't come here to debate this.

My only point is that a business minded psychiatrist will also have access to new revenue streams after a few years of practice. Different ones than an ophtho, sure, but money is money...at least to me. I really don't care whether it came from my 3 employed psychiatrists and 3 mid levels plus other business ventures, or if it came from the fees for a surgical center. It all goes to the same place.

Things we can get into that ophtho can't: therapists, suboxone, addictions treatment for the rich (horse farm near me charges 30k/mo per pt), private schools for rich kids with developmental problems/autism, telepsychiatry...the list goes on.
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any MD/DO can do suboxone with the course(and most all psychs still need the course just as a derm would).....PART of the reason that psychiatrists and family medicine docs do it more than any other is because these two make less per patient encounter(along with peds) than any others, so it makes more sense for them to do it.

It doesn't make financial sense for an ent to do suboxone because he makes more money per office procedure doing what he does than he would on suboxone. If suboxone suddenly became financially favorable for these people, they would definately be doing it.

But again, most all of what you describe isn't really additional revenue streams. They just involve seeing more patients. Everyone can see more patients and make money.
 
In General, it's the business plan you create. This is based on how creative and which opportunities present themselves. Good networking skills help.

But alas, I cannot help but notice, Vistaril lives!
 
Shikima said:
In General, it's the business plan you create. This is based on how creative and which opportunities present themselves.
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huh? Any business plan in psychiatry involves.....seeing patients/patient encounters. That, unlike some specialties, is the source of income for anything. Sure the patient encounters can theoretically vary from med mgt checks to therapy to group therapy to suboxone to court appted evals to contracts with nursing homes to testifying in court to use of midlevels to do med mgt or therapy or groups or whatever. But at the core of all this.....it's still based on the patient encounter. That is the driving force for where virtually ALL the money in psychiatry comes from, especially in the outpt world(and very few inpatient psychs are going to have a stake in anything)

Whereas in other specialties, the patient encounter itself is often the most important source of income(either through them or their midlevels, which in primary care they have more opportunities with), but there are tons of others.......
 
F0nzie said:
Even if you released your parents step-by-step guide, 99% of the psychiatrists on here won't follow it because it's too much work. It's far more desirable to get paid by the hour seeing patients than learning how to enter data in Quickbooks. I think your parents might be a bit paranoid over losing revenue from posting their "secrets" on SDN.
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lol it isn't like that

my parents aren't business-minded doctors. they see the clinic as a place to more closely fit their ideal vision of how a psychiatrist should practice

i just don't want to deal with it the next time i talk to them over skype haha

i just wanted to point out that comparing the top end of medical specialties because it has more to do with how driven an individual is regarding profits/business than the specialty itself. it is better to know the baseline for your medical specialty in the area you want to practice.
 
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vistaril said:
But again, most all of what you describe isn't really additional revenue streams. They just involve seeing more patients. Everyone can see more patients and make money.
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Sigh. Yeah, but we're talking about a business. Growing a business means hiring additional employees. With the right business plan, there's no limit to the number of "patient encounters" one could have in psychiatry. There is such a huge shortage that if you set up shop and take insurance in most areas you'll be full fairly quickly and able to hire a second person. Then they'll be full. Then you can hire a 3rd to do Suboxone. Then you can open a boutique rehab. Then you can open a 2nd office in a nearby city and wash, rinse, and repeat. Yes, any specialty could do this, but the mental health shortage makes it particularly more advantageous for us compared to some other specialties that are a dime a dozen.

Again, you seem to be missing my point. My point is simply that a business minded psychiatrist can grow their practice, hire extra employees, and generate extra income without doing increased work...just as any other business oriented physician can.
 
digitlnoize said:
Sigh. Yeah, but we're talking about a business. Growing a business means hiring additional employees. With the right business plan, there's no limit to the number of "patient encounters" one could have in psychiatry. There is such a huge shortage that if you set up shop and take insurance in most areas you'll be full fairly quickly and able to hire a second person. Then they'll be full. Then you can hire a 3rd to do Suboxone. Then you can open a boutique rehab. Then you can open a 2nd office in a nearby city and wash, rinse, and repeat. Yes, any specialty could do this, but the mental health shortage makes it particularly more advantageous for us compared to some other specialties that are a dime a dozen.

Again, you seem to be missing my point. My point is simply that a business minded psychiatrist can grow their practice, hire extra employees, and generate extra income without doing increased work...just as any other business oriented physician can.
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This sounds really great - and forgive my ignorance, but I am not sure how this would really work. If you hire an APRN, then how does that get you more money? Are you likely going to be able to hire someone for so much less money than what you can bill for their services that the difference is enough to cover all your expenses and lead to a profit? If so, that would be great of course - are a lot of people doing this in practise? The psychiatrists I know that work with APRN's essentially just share the costs of an office and receptionist, and each party then keeps what they are able to bill for. Of course I don't know hundreds of people in private practise, so if there are people growing business the way you describe I would love to know more about how that works!
 
digitlnoize said:
Sigh. Yeah, but we're talking about a business. Growing a business means hiring additional employees. With the right business plan, there's no limit to the number of "patient encounters" one could have in psychiatry. There is such a huge shortage that if you set up shop and take insurance in most areas you'll be full fairly quickly and able to hire a second person. Then they'll be full. Then you can hire a 3rd to do Suboxone. Then you can open a boutique rehab. Then you can open a 2nd office in a nearby city and wash, rinse, and repeat. Yes, any specialty could do this, but the mental health shortage makes it particularly more advantageous for us compared to some other specialties that are a dime a dozen.

Again, you seem to be missing my point. My point is simply that a business minded psychiatrist can grow their practice, hire extra employees, and generate extra income without doing increased work...just as any other business oriented physician can.
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But again, in optho(because someone else mentioned that field) the basic model of practice for people who transition from junior associate positions in groups to partners involves very lucrative revenue sources(facility fees, optical shops). I'm not talking about some pie in the sky 'business minded' optho......most every optho group with multiple opthos has an optical center for example.
 
Confused about recruiters:

I might have missed this topic of discussion, but has anyone gone through a recruiter? I saw pretty sweet job offers, but they just name a general area and give you a salary range. I am obviously cautious, but I would want to know if there are any stories out there/any advice when dealing with recruiters.

Here are a few links as examples:

http://www.merritthawkins.com/job-search/job-details.aspx?job=11762&contract=160286

http://www.merritthawkins.com/job-search/job-details.aspx?job=10924&contract=161747
 
Extralong said:
Confused about recruiters:

I might have missed this topic of discussion, but has anyone gone through a recruiter? I saw pretty sweet job offers, but they just name a general area and give you a salary range. I am obviously cautious, but I would want to know if there are any stories out there/any advice when dealing with recruiters.

Here are a few links as examples:

http://www.merritthawkins.com/job-search/job-details.aspx?job=11762&contract=160286

http://www.merritthawkins.com/job-search/job-details.aspx?job=10924&contract=161747
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think about it- if they need to resort to such things to fill the job, how good is it?

Most of these 'sweet job' offers are only sweet on paper. In reality the 300k+ bolded in the job ad is based on production(or usually a % collection on billings) that simply isn't realistic.
 
vistaril said:
think about it- if they need to resort to such things to fill the job, how good is it?

Most of these 'sweet job' offers are only sweet on paper. In reality the 300k+ bolded in the job ad is based on production(or usually a % collection on billings) that simply isn't realistic.
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Actually, guessing that I know both of those communities, I wouldn't hesitate to suggest that one of my residents interview there. Worth a look at least (especially the first one--likely Eau Claire area--nice town. Underserved, but you wouldn't be alone, either). ;)
 
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vistaril said:
think about it- if they need to resort to such things to fill the job, how good is it?
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They are recruiting for Wisconsin and rural Michigan. Underserved areas can't fill on word-of-mouth alone. If they could, they wouldn't be so underserved.

Some jobs go the headhunter route because they are awful jobs and can't keep staff. Others can't recruit through local contacts alone because of location.
 
I'm working with a recruiter right now. I'll keep you posted on my impressions. So far he's found me a LA county job with great benefits in Hollywood. Sounds a bit too good to be true so far.

I just got done with my first month in privite practice and when collections gets through I better have a huge check because I have been working 7 days a week for the last month with the exception of July 4th. I'm honestly exhausted and am starting to feel like nothing could be worth this much work. Which is why I'm even talking to a recruiter in the first place. I don't mind being busy but I need my weekends. And right now I am not getting them. And I absolutely hate it.
 
gibits said:
I'm working with a recruiter right now. I'll keep you posted on my impressions. So far he's found me a LA county job with great benefits in Hollywood. Sounds a bit too good to be true so far.

I just got done with my first month in privite practice and when collections gets through I better have a huge check because I have been working 7 days a week for the last month with the exception of July 4th. I'm honestly exhausted and am starting to feel like nothing could be worth this much work. Which is why I'm even talking to a recruiter in the first place. I don't mind being busy but I need my weekends. And right now I am not getting them. And I absolutely hate it.
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Why are you working 7 days a week? Are you seeing patients all those days or is part of that you having to do a lot of administrative/start-up work for your practice?
 
HealthHare said:
Why are you working 7 days a week? Are you seeing patients all those days or is part of that you having to do a lot of administrative/start-up work for your practice?
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I'm seeing patients all those days. Aside from my daily charting at the inpatient units I have SNFs to go to and consults that need to be done within 24 hours. We have an army of administrators. I've joined an established practice so no start up. All the infrastructure is in place already. It's just that busy.

Honestly, I'm wondering if anyone else in privite practice has just as bad or am I just being a whiney bitch? I don't mind being busy but I need rest and time with my family.
 
gibits said:
I'm seeing patients all those days. Aside from my daily charting at the inpatient units I have SNFs to go to and consults that need to be done within 24 hours. We have an army of administrators. I've joined an established practice so no start up. All the infrastructure is in place already. It's just that busy.

Honestly, I'm wondering if anyone else in privite practice has just as bad or am I just being a whiney bitch? I don't mind being busy but I need rest and time with my family.
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Maybe this is just semantics, but this really isn't private practice. You are an independent contractor for a few hospitals and nursing homes. Private practice, to most psychiatrists, means outpatient work, where you are billing your patients or their insurance directly, as opposed to some hospital or community mental health clinic doing this for you. The implication of private practice is that you are running a business, not simply seeing patients in an unsupervised fashion. Or maybe I have it wrong.
 
strangeglove said:
Maybe this is just semantics, but this really isn't private practice. You are an independent contractor for a few hospitals and nursing homes. Private practice, to most psychiatrists, means outpatient work, where you are billing your patients or their insurance directly, as opposed to some hospital or community mental health clinic doing this for you. The implication of private practice is that you are running a business, not simply seeing patients in an unsupervised fashion. Or maybe I have it wrong.
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No, I do outpatient as well. Indeed most of my working time is in the office. My day is usually inpatient in the AM and the office in the PM. Officially I am a contractor, as in I dont get any benefits and pay for my own insurance.
I bill for myself and not the practice. Which is the main draw of the job.
 
If you're contracting, did you do a fixed bid or hourly?
 
notdeadyet said:
If you're contracting, did you do a fixed bid or hourly?
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I'm not sure. I'm just paid by the insurance reimbursements. The practice takes 30% for overhead. I know for a fact I'm not on salary.
 
notdeadyet said:
If you're contracting, did you do a fixed bid or hourly?
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there is a lot of 'contract work' out there where some agency or facility(DHR in some cases I know of) simply funnels you patients and guarantees virtually no no shows(since the patients are already there) and you do all the billing yourself. They don't pay you anything per hour, and in some cases actually want a small cut in exchange for them giving you patients.
 
gibits said:
I'm not sure. I'm just paid by the insurance reimbursements. The practice takes 30% for overhead. I know for a fact I'm not on salary.
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30% is a little high, but may be acceptable depending on the circumstances (ie, malpractice covered, no non-compete, good payor mix, licensure and credentialing fees covered).

Are your services being billed individually (which would make you more of a sole proprietor rather than an independent contractor) or are you credentialled as a member of the group and billing under the group???
 
michaelrack said:
30% is a little high, but may be acceptable depending on the circumstances (ie, malpractice covered, no non-compete, good payor mix, licensure and credentialing fees covered).

Are your services being billed individually (which would make you more of a sole proprietor rather than an independent contractor) or are you credentialled as a member of the group and billing under the group???
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Each patient is billed individually. I'm credentialed independently as well. I have to pay my own malpractice and tail coverage. If I'm a sole proprietor then how much say do I have in regards to how many weekends I get off? That's really my main gripe with this job so far.
 
gibits said:
Each patient is billed individually. I'm credentialed independently as well. I have to pay my own malpractice and tail coverage. If I'm a sole proprietor then how much say do I have in regards to how many weekends I get off? That's really my main gripe with this job so far.
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1. One determinant legally would be medicare (even if you see few medicare patients). I will assume that your medicare payments come in your name and are not assigned to the group (even if they payments go to a checking acct the group has control over, which is probably ok).

2. I was a little bit confused/muddled earlier about sole proprietor/independent contractor. They can be the same thing; sorry about that. The key issue is whether you are an employee or not. And it sounds like they told you that you are not an employee, that you are an independent contractor. Let's just keep the term independent contractor for further discussion.

3. As far as payments to you, I assume they are not treating you as an employee- they are not withholding taxes and not paying the employer half of social sec/medicare. As far as payment for your services, it sounds like they are treating you as an independent contractor.

4. As an independent contractor, you are supposed to have some degree of control over your own work (see common law rules at http://www.irs.gov/Businesses/Small...ndent-Contractor-(Self-Employed)-or-Employee?)

There are remedies available- see further down in the document- if your employment status has been misclassified.

5. As far as working weekends, that depends. If they are telling you exactly what hours to work on weekends, that could be against independent contractor rules. On the other hand, if they are contracting you to round at a nursing home on weekends, and aren't too specific about hours, that may be ok.
 
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michaelrack said:
5. As far as working weekends, that depends. If they are telling you exactly what hours to work on weekends, that could be against independent contractor rules. On the other hand, if they are contracting you to round at a nursing home on weekends, and aren't too specific about hours, that may be ok.
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the thing about a lot of these jobs is that you have to tailor your hours to when the patients are going to be there. A friend of mine works for state child services in much the same setup as this...independent contractor where he bills himself, covers his own malpractice, has to collect himself, etc....the state just provides the patients. The advantage for him is that his no show rate is effectively zero(since they are already there), but he's got to tailor his visits with these kids to when they are going to be available for him on site to pull them away for his appt.
 
vistaril said:
the thing about a lot of these jobs is that you have to tailor your hours to when the patients are going to be there. A friend of mine works for state child services in much the same setup as this...independent contractor where he bills himself, covers his own malpractice, has to collect himself, etc....the state just provides the patients. The advantage for him is that his no show rate is effectively zero(since they are already there), but he's got to tailor his visits with these kids to when they are going to be available for him on site to pull them away for his appt.
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Vistaril, from what you describe, the state has little control over the working conditions, other than setting up the time for the kids to be available. In addition your friend is doing his own billing. Your friend is not an employee of the state. (edit: are you trying to say that your friend is an independent contractor for a practice, and that the set hours shouldn't count against independent contractor status because that is when the state makes patients available to members of the practice, and it is the state not the practice setting those hours? I would agree with that)

The situation is a little more blurry for gibits- it sounds like the practice is doing the billing and collections.
 
Gibits, figuring out whether you have been properly classified as an independent contractor (vs. an employee), is probably not helpful to your situation. The group/practice you are working with has classified you as an independent contractor, and I guess you will have to live with that for now.

Here are my recommendations to you:

Keep on working in your current situation without complaint for the next few months. At the end of the 4th month, divide your collections (after the 30% overhead has been subtracted) for the 4th month by the number of hours you worked in the 3rd month. This will give you a crude estimate of how much you are making per hour.

If you are making more then $130/ hour, I would recommend staying with the current situation. If you are making less then $100/hr, you should start making preparations to leave.

If you are making between 100-130/hr, then you need to closely monitor the situation, repeat the above calculation every month, and start negotiating with the group. Try to negotiate a slight reduction in overhead, weekends off, etc. Consider a non-urgent search for a better opportunity.

Originally I was going to use 125 as the cutoff, but raised it to 130 to take into account that you have to pay malpractice on your own, as well as cover the amount of the "self-employment tax".
 
vistaril said:
yes but in 10+ years the optho has a partnership stake, is collecting % of facility fees for gobs of patients at the outpt surgery suite they own, has a stake in the refraction/glasses/contacts area, and 2-3 other revenue streams besides his direct billings to pts. Maybe he does start at 190, but if he works hard he has a real chance to be at 4 times that in a decade.

It's a totally different pay structure and ridiculous to compare starting salaries between the two.
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All those extra income sources won't be around for long.

Enter obamacare/ACOs.
 
Thanks michealrack, thats some sound advice. Basically keep my head to the ground and see. Your cutoff is Pre or post tax? I think I might be on the bubble if post taxes.
 
gibits said:
Thanks michealrack, thats some sound advice. Basically keep my head to the ground and see. Your cutoff is Pre or post tax? I think I might be on the bubble if post taxes.
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You are welcome

Those figures don't take into account taxes (they are pre-tax). For example, if you worked 200 hours in September and collected a total of $30,000 in October:

that would give you total income of 21,000 (after subtracting the 9000 overhead) divided by 200 hours for an hourly wage of $105. The $105 hourly wage would put you in the borderline zone of 100-130/hr.
 
michaelrack said:
Vistaril, from what you describe, the state has little control over the working conditions, other than setting up the time for the kids to be available. In addition your friend is doing his own billing. Your friend is not an employee of the state. (edit: are you trying to say that your friend is an independent contractor for a practice, and that the set hours shouldn't count against independent contractor status because that is when the state makes patients available to members of the practice, and it is the state not the practice setting those hours? I would agree with that)

The situation is a little more blurry for gibits- it sounds like the practice is doing the billing and collections.
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good point...Im not sure on all the details
 
Kal EI said:
All those extra income sources won't be around for long.

Enter obamacare/ACOs.
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people have been saying that for 20 years....and yet optho partners can still get plenty of fiancing for their second beach home in most cases.
 
michaelrack said:
Agree with Vistaril. With glasses/optometry usually being separate from standard medical insurance benefits, I don't think this source of revenue is going to dry up for opthalmologists.
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Glasses/optometry ... :screwy:
That market is so incredibly saturated by huge corporations (lenscrafters, pearl vision, etc)
You are living in the far past. What these other specialties have made before is just no longer attainable for the established private practice docs let alone new grads. I don't know what sheltered holes you live in, but obamacare will force everyone in to employment and 200-400k salaries. Privately owned practice will cease to exist completely and everyone will be employed by an Accountable Care Organization.
 
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BS81 said:
Glasses/optometry ... :screwy:
That market is so incredibly saturated by huge corporations (lenscrafters, pearl vision, etc)
You are living in the far past. What these other specialties have made before is just no longer attainable for the established private practice docs let alone new grads. I don't know what sheltered holes you live in, but obamacare will force everyone in to employment and 200-400k salaries. Privately owned practice will cease to exist completely and everyone will be employed by an Accountable Care Organization.
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Why are we talking about ophthalmologists again? Who the hell wants to sell glasses?
Yes, we all know that it is no longer 1985 and Fee for Service is not what it used to be.
But what's wrong with 200-400k? That doesn't sound so horrible, and pretty much in the range of what most psychiatrists earn. Also, it's much more enjoyable than opthomology.
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Also, I am very skeptical when you suddenly assert that the Affordable Care Act will "force everyone into employment" and cause private practice to cease to exist.
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Since someone brought up the ACA (don't say Obamacare, you instantly lose objective credibility), how do you think it will affect psychiatrists' pay? We don't do that many procedures and most of our clients don't have insurance (like addicts, downward spiraled schizophrenics, homeless people looking for a place to stay). Will mandatory coverage make any real difference?

PS forcing people into employment sounds like a great thing considering the high unemployment rates nowadays.
 
gibits said:
Since someone brought up the ACA (don't say Obamacare, you instantly lose objective credibility), how do you think it will affect psychiatrists' pay? We don't do that many procedures and most of our clients don't have insurance (like addicts, downward spiraled schizophrenics, homeless people looking for a place to stay). Will mandatory coverage make any real difference?.
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I will say that the ACA has helped quite a bit for those 20-25 y/o who can get care via their parents' policies. That has made a difference for a lot of our overdose/CD kinds of youthful foolishness kinds of admissions.

Ultimately it's not going to affect our pay, dare I say, at all. The real adjustments in reimbursements are all going to come out of CMS--Center for Medicare Services--anyway. They already set rates for half of the care in this country, and via indirect market effects, heavily influence the rest. This has been going on since long before Obama--and if Repubs are "successful" in repealing ACA, is what they will have to deal with if and when they take a shot at health care reform. Complaining about "Obamacare" is just a smokescreen...
 
wolfvgang22 said:
Why are we talking about ophthalmologists again? Who the hell wants to sell glasses?
Yes, we all know that it is no longer 1985 and Fee for Service is not what it used to be.
But what's wrong with 200-400k? That doesn't sound so horrible, and pretty much in the range of what most psychiatrists earn. Also, it's much more enjoyable than opthomology.
TqYM425.jpg


Also, I am very skeptical when you suddenly assert that the Affordable Care Act will "force everyone into employment" and cause private practice to cease to exist.
7dKpZXU.jpg
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This has been an ongoing trend with the increased restrictions, but the ACA has accelerated things further. EMR is expensive, bundled services, integrated care forces physicians to conglomerate under a big corporate umbrella. And 200-400k is just fine. I think this will encourage people to do what they love more than chase the outrageous money that used to be available.

http://news.heartland.org/newspaper-article/obamacare-expected-increase-loss-doctor-owned-practices

http://www.nytimes.com/2010/03/26/health/policy/26docs.html?pagewanted=all&_r=0

http://money.cnn.com/2013/07/16/smallbusiness/doctors-selling-practices/index.html

http://articles.washingtonpost.com/...6_1_medicare-cuts-physician-practices-doctors

And I'm mostly replying to the people certain that everyone else makes so much money outside of psychiatry. The people that made the huge bucks OWNED their own practice, billed for their procedures, diagnostic tests, etc. Here's an interesting quote from the washpost piece. This happened to cardiologists, radiologists, then oncologists, then radoncs, and GI is up on the chopping block next...

In large part it is due to how Medicare pays doctors. Three years ago, a cardiologist colleague educated me over a coffee at Starbucks about Medicare payments for office procedures. He said, “Medicare has cut reimbursements to us by 10 to 40 percent. But they have not cut payments to hospitals.” With resentment, he pointed out that Medicare would pay $180 for an echocardiogram in his office but $450 at the hospital down the street.

Hearing the complaint, I was not entirely sympathetic. Medicare was focusing on individual doctors because many doctor-owned practices also included a testing facility, and studies had shown that in such cases the doctors often overprescribed Medicare-reimbursable tests for their patients. “That’s likely why Medicare cut payment to doctors’ offices,” I told him.

Medicare cuts have had a big impact on cardiologists and oncologists in particular. Rumors were that my colleague’s cardiology practice, which had invested heavily in diagnostic equipment, was going bankrupt. The practice was unable to sustain the overhead of a new building and the high physician salaries once Medicare starting cutting back reimbursements.


That’s when the hospital stepped in. The hospital was willing to buy the practice, clear the debt and promise the doctors handsome salaries, similar to what they had made in a good year, for the first few years, with uncertainty after that. Once the practice was owned by the hospital, it would receive the higher Medicare payments for echocardiograms and other procedures.
Click to expand...
 
I heard the EMR users will get a bonus or at least not receive a cut. Is this true? And if so by how much of a percent? I'm already using a bootleg version (self made template) at my office and all the hospitals I do inpatient and C&L at. Many older MDs seem to hate this push. Are they right to feel this way?
 
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