What are some different models of a psychiatrists' lifestyle after residency?

[Shufflin]

Wow, who the heck makes 500k working 35 hours a week! That's amazing. My application is pretty average so I'm probably not going to get into the best residency. Can you explain what you mean by "crappy?" By crappy, do you mean low pay? If I could earn 150k a year, working at low stress for <30 hours or so, I'd take that job in a heartbeat.

Or $650K working 30 to 35hrs a week, and in CA of all places. You're looking for a family-friendly medical specialty and we're saying here, you've got one.

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[nebuchadnezzarII]

Let me guess: Asian parents? They have no clue what they are talking about. They also don't know what a typical psych practice look like.

American medical systems are very different from in Asia or Europe, and mental health care here is very different. Your thinking on this is not clear. Employed jobs don't pay $150 per med check. $150 is gross REVENUE per billing. There's a big difference between getting a job and starting a practice. The main advantage of psych which you haven't appreciated though several above posters repeated try to drill is that it's very very easy to start a practice with psych. In that way psych is very similar to derm. And all the advantages of derm are also similar. Unlike derm, however, there's also a robust demand for psych in the public (non-cosmetic) sector. Trying reading a few books on starting a business, etc. The best jobs in psych are not "jobs"--they require owning equity. See if you can figure out what that means. This is after all America. The best jobs period are not jobs.

Think of psych as a more selective IM mainly outpatient subspecialty with better hours (i.e. allergy, etc), and much better job market (prolly one of the best in all of medicine right now). Job market can change though so that's not such a great metric for picking a job.

Thanks. I know very little about starting a practice. I didn’t understand that’s what people were implying. I prefer to be an employee and work few hours with little stress. I’d be fine making 150k for 30 hours or so.

 

[BiscoDisco]

If I could earn 150k a year, working at low stress for <30 hours or so, I'd take that job in a heartbeat.

As a PGY1 who will be entering the workforce in 4 years...please, don't do this. We are worth far more than 150k for 30 hours.

 

[nebuchadnezzarII]

As a PGY1 who will be entering the workforce in 4 years...please, don't do this. We are worth far more than 150k for 30 hours.

Haha. Even in a big NE metro area?

 

[BiscoDisco]

Two more quick questions and I swear I'll leave you alone. I hate to be this annoying, but it's difficult to commit to something in life without knowing all the ins and outs.

1. This $150 a hour med-check outpatient type of job. Is that hard to get? As in, would I need an Ivy League or reputable residency to be considered for those jobs as an attending?

2. Do you foresee a shortage in the demand for psychiatry. My parents (who are not in the medical field mind you) are terrified that I will have no job prospects in psychiatry. I keep hearing there is a psychiatry shortage but what this means, I don't know. Does this mean that I can easily get employed as a psychiatrist ANYWHERE? Does it mean that only certain locations are in need of psychiatrists? Can I just access these locations through telepsych?

Insurance/medicare doesn't reimburse higher based on where you did residency.

 

[nebuchadnezzarII]

Insurance/medicare doesn't reimburse higher based on where you did residency.

I was more talking about employers.

 

[BiscoDisco]

Haha. Even in a big NE metro area?

Even academics pays more than that.

 

[nebuchadnezzarII]

Even academics pays more than that.

Seriously? For 30 hours? I had no idea. I thought academics paid like 120k full time.

 

[BiscoDisco]

Seriously? For 30 hours? I had no idea. I thought academics paid like 120k full time.

I'm sure there are exceptions in the ivoriest of ivory towers where that is true.

 

[nebuchadnezzarII]

I'm sure there are exceptions in the ivoriest of ivory towers where that is true.

Interesting. I am a MS 3 so I really don’t know. I’m just going by stuff I’ve read here. How is PGY 1 going? Was your IM rotation hard? Do you have any comments on the job security of psychiatry?

 

[clausewitz2]

I'm sure there are exceptions in the ivoriest of ivory towers where that is true.

We are relatively fancy but not in a fancy city. Our full time outpatient docs start at about 165k.

 

[nebuchadnezzarII]

We are relatively fancy but not in a fancy city. Our full time outpatient docs start at about 165k.

How long is full-time?

 

[clausewitz2]

How long is full-time?

About 40 hours a week, +/- a bit of protected time for education etc.

They do have a small call obligation they can get paid extra for but some outpatient faculty always manage to give their shifts away.

 

[nebuchadnezzarII]

About 40 hours a week, +/- a bit of protected time for education etc.

They do have a small call obligation they can get paid extra for but some outpatient faculty always manage to give their shifts away.

I was worried salaries would be 160k or so. Everyone on here makes it seem like you get 220k starting out.

 

[clausewitz2]

I was worried salaries would be 160k or so. Everyone on here makes it seem like you get 220k starting out.

All of the people doing this are doing it to be at a big deal academic institution. If they went across the river to the competing hospital system their salaries would go up by at least 50k and they would still teach residents.

 

[Mass Effect]

2. Do you foresee a shortage in the demand for psychiatry. My parents (who are not in the medical field mind you) are terrified that I will have no job prospects in psychiatry. I keep hearing there is a psychiatry shortage but what this means, I don't know. Does this mean that I can easily get employed as a psychiatrist ANYWHERE? Does it mean that only certain locations are in need of psychiatrists? Can I just access these locations through telepsych?

Show your parents my inbox (attached)

I'm sure there are exceptions in the ivoriest of ivory towers where that is true.

Nope. I got an offer from one of the ivoriest of ivory and base pay was in the 190 range.

 

[FlowRate]

Thanks. I know very little about starting a practice. I didn’t understand that’s what people were implying. I prefer to be an employee and work few hours with little stress. I’d be fine making 150k for 30 hours or so.

The people employing you would be fine with that, as well.

As a PGY1 who will be entering the workforce in 4 years...please, don't do this. We are worth far more than 150k for 30 hours.

I'm sure there are exceptions in the ivoriest of ivory towers where that is true.

150k would unfortunately be good for a clinical academic 0.75 FTE around here.

 

[BiscoDisco]

The people employing you would be fine with that, as well.


150k would unfortunately be good for a clinical academic 0.75 FTE around here.

My misunderstanding. I thought 30 hours of clinical work in academics was definitely considered full time.

 

[ArdorAyurveda]

What do drug prices have to do with office visits with the doctor? We're not the ones selling the drugs.

My line of thought is that if drug prices will fall, then insurance companies will reimburse less for med management appointments. I have to read more about how reimbursement is determined for med management appointments. This is assuming that you take insurance.

If you're in private practice and doing cash only, does your revenue essentially come from having a high co-pay + charging a high hourly fee?

Trying reading a few books on starting a business, etc. The best jobs in psych are not "jobs"--they require owning equity. See if you can figure out what that means. This is after all America. The best jobs period are not jobs.

Totally agree with you here. Ownership > Being an employee.

Do you really think reading books helps, though? After a certain point, you just have to put your head down and take the necessary steps to match into psych, pick your location, start your business, network, etc.

What advice would you give to an incoming medical student that is interested in private practice psych? Assume that the student is more interested in the freedom of being a business owner rather than simply having the highest income possible.

For instance, SDN dogma states that someone interested in psych needs to get the highest board score possible and needs to have as many publications as possible. But how much is enough?

Especially considering that I don't want to be a researcher nor am I inclined to work in an academic institution?

I'd much rather spend my time in med school on a psych-related project that is creative and self-directed, rather than cleaning up data on a clinical research project. Not saying that clinical research isn't important, but if I only have limited free time, I'd rather spend it on something that I am intrinsically motivated to achieve...

Any suggestions?

@Mass Effect Thanks for sharing. I will definitely show this to my overbearing, immigrant parents. Not Asian, but still hypervigilant and literally begging me to do anything other than psychiatry.

 

[dl2dp2]

My line of thought is that if drug prices will fall, then insurance companies will reimburse less for med management appointments. I have to read more about how reimbursement is determined for med management appointments. This is assuming that you take insurance.

Drug pricing is unrelated to physician fee schedule.

If you're in private practice and doing cash only, does your revenue essentially come from having a high co-pay + charging a high hourly fee?

You charge whatever the market can bear if you are doing cash only.

Do you really think reading books helps, though? After a certain point, you just have to put your head down and take the necessary steps to match into psych, pick your location, start your business, network, etc.

What advice would you give to an incoming medical student that is interested in private practice psych? Assume that the student is more interested in the freedom of being a business owner rather than simply having the highest income possible.

For instance, SDN dogma states that someone interested in psych needs to get the highest board score possible and needs to have as many publications as possible. But how much is enough?

Especially considering that I don't want to be a researcher nor am I inclined to work in an academic institution?

These are separate issues. Most people matching into ortho or derm don't want to be researchers, but they still gun for as many publications and best board score as possible. You also always develop a narrative so that you can get into the best academic institution possible. Academic institutions KNOW this, and are FINE with it. They need cheap labor at earlier career stages, and you fill the need. You need their brand. Do whatever it takes to get into the best program, and THEN your options get much broader afterward. If you want to maximize your freedom later I would buckle down and play the game early. If you really are craving running a business, I would just start a business now (i.e. do some real estate investing, etc). If you are really interested in practice management and policy, issues relating to reimbursement and patient flow etc, there are legit implementation science research you can be engaged in and would develop credentials for a "top" academic program.

Once you are in a top program, your career options expand in several ways. One is obviously academic/research career, which pays little but has other rewards. Second is a managerial ("administrative") career, which requires stepwise movement institutionally, with some shortcuts (i.e. specific management training, etc). Think of this as climbing the corporate ladder. This is also relevant if you want a senior policy job in the public sector. Third is "solo cash" or partnership track at a lucrative small group practice. Think of this as running any kind of boutiquey small business--branding is very important (though not in and of itself sufficient), and wealthier clients look for relevant brands. In terms of mid career transitions option 1 <---> option 2 tend to have overlap, both option 1/2 --> 3 but 3 rarely go back to 2 or 1, because 3 makes on average the most money and has the best lifestyle, but 1 and 2 are considered more prestigious. These jobs are not as accessible if you don't start out at a "top" program.

3 is very hard to do in general IM (and very few other specialties), relating to 1) psych has lower overhead, 2) logistically no advantage of picking a hospital vs. solo practice of physicians who trained at a reputable institution (i.e. the economy of scale is not as obvious)--don't need a scrub nurse, fluoroscopy suite etc. Other high paying specialties are totally different models mainly having to do with high reimbursement of procedures. Interventional rads has sky high overhead, but right now their facility fee and reimbursement rates are sky high also. These are issues to think about because these specialties are much more tethered to global reimbursement negotiations and will be more affected by systemic changes.

In psychiatry there are also decent public staff jobs (i.e. a suburban VA that's mostly reasonably good patients that has a very high salary), but they are rare and would typically they also attract top graduates through word of mouth. Good subspecialty staff jobs (say medical director at a private rehab facility or wealthy adolescent day program, that type of job) also tend to attract top graduates. A very common arrangement in psych is part time public/facility based job (even shift based), with benefits, and part time private practice. These kinds of flexible things are hard to do in IM/procedural specialties. As a MS I would not worry about these practice management nuances, since once you start residency what's materially more interesting (i.e. inpt vs. outpt vs ER vs. IOP vs. various subspecialties etc) to you would become very obvious.

 

[nebuchadnezzarII]

Drug pricing is unrelated to physician fee schedule.



You charge whatever the market can bear if you are doing cash only.




These are separate issues. Most people matching into ortho or derm don't want to be researchers, but they still gun for as many publications and best board score as possible. You also always develop a narrative so that you can get into the best academic institution possible. Academic institutions KNOW this, and are FINE with it. They need cheap labor at earlier career stages, and you fill the need. You need their brand. Do whatever it takes to get into the best program, and THEN your options get much broader afterward. If you want to maximize your freedom later I would buckle down and play the game early. If you really are craving running a business, I would just start a business now (i.e. do some real estate investing, etc). If you are really interested in practice management and policy, issues relating to reimbursement and patient flow etc, there are legit implementation science research you can be engaged in and would develop credentials for a "top" academic program.

Once you are in a top program, your career options expand in several ways. One is obviously academic/research career, which pays little but has other rewards. Second is a managerial ("administrative") career, which requires stepwise movement institutionally, with some shortcuts (i.e. specific management training, etc). Think of this as climbing the corporate ladder. This is also relevant if you want a senior policy job in the public sector. Third is "solo cash" or partnership track at a lucrative small group practice. Think of this as running any kind of boutiquey small business--branding is very important (though not in and of itself sufficient), and wealthier clients look for relevant brands. In terms of mid career transitions option 1 <---> option 2 tend to have overlap, both option 1/2 --> 3 but 3 rarely go back to 2 or 1, because 3 makes on average the most money and has the best lifestyle, but 1 and 2 are considered more prestigious. These jobs are not as accessible if you don't start out at a "top" program.

3 is very hard to do in general IM (and very few other specialties), relating to 1) psych has lower overhead, 2) logistically no advantage of picking a hospital vs. solo practice of physicians who trained at a reputable institution (i.e. the economy of scale is not as obvious)--don't need a scrub nurse, fluoroscopy suite etc. Other high paying specialties are totally different models mainly having to do with high reimbursement of procedures. Interventional rads has sky high overhead, but right now their facility fee and reimbursement rates are sky high also. These are issues to think about because these specialties are much more tethered to global reimbursement negotiations and will be more affected by systemic changes.

In psychiatry there are also decent public staff jobs (i.e. a suburban VA that's mostly reasonably good patients that has a very high salary), but they are rare and would typically they also attract top graduates through word of mouth. Good subspecialty staff jobs (say medical director at a private rehab facility or wealthy adolescent day program, that type of job) also tend to attract top graduates. A very common arrangement in psych is part time public/facility based job (even shift based), with benefits, and part time private practice. These kinds of flexible things are hard to do in IM/procedural specialties. As a MS I would not worry about these practice management nuances, since once you start residency what's materially more interesting (i.e. inpt vs. outpt vs ER vs. IOP vs. various subspecialties etc) to you would become very obvious.

Damn man all that sounds so complicated. I didn’t know you had to be so business minded to make good money.

 

[FlowRate]

These jobs are not as accessible if you don't start out at a "top" program.

Since we're basically on this topic already, any suggestions for getting connected with this sort of thing outside your geographic region? The typical advice is to network at conferences but in my prior experience (although maybe not close enough to predict for psych job hunting) that has actually been pretty low yield.

 

[Sushirolls]

IM & FM can do far better than psychiatry in their own private practice. Cash only retainer practices called: Boutique, retainer, micro practice, cash only. i.e. cash only practice where patients are billed $100/month for potentially unlimited access to the doctor. Patient panel goes from 4000 in primary care down to 200-800 patients. Maybe only need one staff. FM/IM can also buck the system, too.

 

[uhmocksuhsillen]

This thread is extremely helpful for us residents, many thanks to all those contributing.

One question I have which @sluox touched on above - I understand going to a Harvard or Yale is going to allow you to land those top jobs or more easily attract cash pay clients. For those who are at a solidly middle-tier big University program, should we count on staying in the that geographic region to reap the benefits our program might allow? My University program has name recognition nationally (the university at large, not the psych program) and is located in a large, affluent city without another psych program.

Or, would I be able to take my training back to one of the coasts and still have an opportunity to land these good jobs/attract cash pay?

 

[romanticscience]

This thread is extremely helpful for us residents, many thanks to all those contributing.

One question I have which @sluox touched on above - I understand going to a Harvard or Yale is going to allow you to land those top jobs or more easily attract cash pay clients. For those who are at a solidly middle-tier big University program, should we count on staying in the that geographic region to reap the benefits our program might allow? My University program has name recognition nationally (the university at large, not the psych program) and is located in a large, affluent city without another psych program.

Or, would I be able to take my training back to one of the coasts and still have an opportunity to land these good jobs/attract cash pay?

In my experience, the economic dynamics of the market you work in matters a lot. Places like NYC, LA, DC have created a culture where not many psychiatrists are in-network and people are expected to pay out of pocket, hopefully having some out-of-network benefit. However, some markets, like the one that I'm in, have a weak cash market. My theory is that there are 1 or 2 big insurance products that most employers offer which allow little or no out of network benefits. This has created a culture where people expect to use their insurances. Even very wealthy patients hope to use their insurance. Granted, I have a few people who pay straight cash, it's not the norm. The upside to this situation is that these insurance products pay decently and allow for a more stable patient panel.

So, there are different strategies, get the fancy diploma to distinguish yourself among the intense competition in a big city for big money or provide consistent quality care in a place with higher demand, lower cost of living, and fair insurance reimbursements.

 

[TexasPhysician]

This thread is extremely helpful for us residents, many thanks to all those contributing.

One question I have which @sluox touched on above - I understand going to a Harvard or Yale is going to allow you to land those top jobs or more easily attract cash pay clients. For those who are at a solidly middle-tier big University program, should we count on staying in the that geographic region to reap the benefits our program might allow? My University program has name recognition nationally (the university at large, not the psych program) and is located in a large, affluent city without another psych program.

Or, would I be able to take my training back to one of the coasts and still have an opportunity to land these good jobs/attract cash pay?

In my experience, the name of the training program has no value. Do good work and have excellent communication skills.

 

[uhmocksuhsillen]

In my experience, the name of the training program has no value. Do good work and have excellent communication skills.

Fair points indeed. I guess what I'm asking is, would coming from a mid-tier university program automatically close doors at top jobs in highly desired coastal cities?

 

[uhmocksuhsillen]

In my experience, the economic dynamics of the market you work in matters a lot. Places like NYC, LA, DC have created a culture where not many psychiatrists are in-network and people are expected to pay out of pocket, hopefully having some out-of-network benefit. However, some markets, like the one that I'm in, have a weak cash market. My theory is that there are 1 or 2 big insurance products that most employers offer which allow little or no out of network benefits. This has created a culture where people expect to use their insurances. Even very wealthy patients hope to use their insurance. Granted, I have a few people who pay straight cash, it's not the norm. The upside to this situation is that these insurance products pay decently and allow for a more stable patient panel.

So, there are different strategies, get the fancy diploma to distinguish yourself among the intense competition in a big city for big money or provide consistent quality care in a place with higher demand, lower cost of living, and fair insurance reimbursements.

So in a city such as LA/SD/SF or DC/NYC, would coming from a mid-tier out of region program make it significantly more difficult to start a cash practice there? AND would it follow that insurance reimbursements are thus lower in cities which have that cash pay culture as you mentioned, thus making it even harder to start a lucrative private practice?

 

[romanticscience]

So in a city such as LA/SD/SF or DC/NYC, would coming from a mid-tier out of region program make it significantly more difficult to start a cash practice there? AND would it follow that insurance reimbursements are thus lower in cities which have that cash pay culture as you mentioned, thus making it even harder to start a lucrative private practice?

I can't say for sure because I've never worked in those cities. However, I've received some supervision from therapists affiliated with name-brand residencies in NYC.

The ceiling is much higher in NYC; you could be treating billionaires. Could you start and run a moderately successful PP with a non-Cornell/Columbia/Sinai/NYU background, sure. Take into consideration the cost of living. But, this is how both the degree AND the network matter. I'm not talking about academics or research; I'm talking about private practice. A reason why, in my opinion, certain residencies are more competitive, is the market they open the doors to. Does Cornell offer much better training than Johns Hopkins? I don't think so. But, your attendings at Cornell may have side PPs and maybe a better referral source than your attendings in Baltimore. For example, who gets these $600/hr (~725/hr in 2019) patients?

Challenges of $600-a-Session Patients (Published 2008)

Wealthy patients, used to getting what they want, can present countless challenges for their therapists.

www.nytimes.com

I believe Dr. Stone is academically affiliated with/an attending at Cornell. You could meet him, maybe receive supervision from him. I did a residency in the midwest. Tons of research grants and academic success; I knew none of them who had a successful side private practice.

 

[AD04]

So in a city such as LA/SD/SF or DC/NYC, would coming from a mid-tier out of region program make it significantly more difficult to start a cash practice there? AND would it follow that insurance reimbursements are thus lower in cities which have that cash pay culture as you mentioned, thus making it even harder to start a lucrative private practice?

I'm not sure if it will be significantly more difficult. It won't be so straight forward as you don't have a built-in network. You will have to be street smart and not just book smart and do some networking. A bit of luck also helps.

I know of someone with a cash practice making good money in the tri-state area (metropolitan area where lots of people want to be) looking to wind down and would like someone younger to step in. I'm not interested in living in the area so I didn't pursue it. Whoever is able to win his trust will have a mentor and access to cash-paying well-to-do patients who are mostly stable.

My program isn't fancy. Yet, I was invited to be part of a practice in NYC and its suburbia comprised of graduates of Cornell / Harvard / other prestigious places. I did notice a bit of haughtiness during the interview. (e.g. The main partner saying, "I can't clone myself, so I need to bring others on-board.") I did bring up that my program is not as prestigious as his and how the patients will react to that. He said that it wouldn't be an issue as he'll vouch for me.

Once you get your foot in the door and earn people's trust by being reliable and valuable, you're golden. Your reputation will spread by word-of-mouth and excellence over time.

There is a DO who only did a 1-year residency and is now treating rich people and celebrities. Of course, he isn't credentialed by any insurance companies so only takes cash.

 

[dl2dp2]

This thread is extremely helpful for us residents, many thanks to all those contributing.

One question I have which @sluox touched on above - I understand going to a Harvard or Yale is going to allow you to land those top jobs or more easily attract cash pay clients. For those who are at a solidly middle-tier big University program, should we count on staying in the that geographic region to reap the benefits our program might allow? My University program has name recognition nationally (the university at large, not the psych program) and is located in a large, affluent city without another psych program.

Or, would I be able to take my training back to one of the coasts and still have an opportunity to land these good jobs/attract cash pay?

These questions don't have quantifiable answers. I think the name of your training program will always be useful to some extent, even if you move around. The effect of that branding is more significant in major markets, and they may be negligible in smaller markets. It's difficult to break into a leadership position or do full time cash practice if you didn't come from the right background, but it's not impossible either. There are prominent FMG researchers, for example. The best way to think about this is figure out what track you want, then talk with local mentors who have been in that track, and tailor your training/career direction in a flexible way.

As of right now, to just get a job whatsoever at any geographical location appears to be trivially easy for any residency grad with no major "red flag" (i.e. probation, etc). But, to get a "good job" or sustain a lucrative practice is not trivial regardless of your background.

So in a city such as LA/SD/SF or DC/NYC, would coming from a mid-tier out of region program make it significantly more difficult to start a cash practice there? AND would it follow that insurance reimbursements are thus lower in cities which have that cash pay culture as you mentioned, thus making it even harder to start a lucrative private practice?

There's no hard and fast rule to any of this. The main point is if you want to keep as many options open, opt for the more competitive residency program, but from a purely credentialing perspective, you wouldn't be ruled out for most of the pure clinical jobs just because you went to a mid tier program. Esp in sub-specialties, I think "networking" is starting to matter less. The mystique of cash practice is waning. Most markets can develop a cash practice. While it is true that many markets have a weak cash presence, the gut feeling of many of us in the field like @TexasPhysician is that the demand for services has increased in the last few years, so cash market (which is already decent) is getting busier. Literally what it is is that you charge $150-$200 (off their HSA account, so pre-tax) for middle class people to come in once a month or two for med management that often make a huge difference in their quality of life and everyone who's taking their insurance has a 3 month wait. This is your garden variety "cash solo". It's not some crazy "celebrity only practice" or Dr. Stone on TV type thing.

On the high end, things are different. I know an NYU faculty charging $2500 for a two hour ADHD intake. This person is a garden variety junior faculty, not even an expert or anything. I don't know what NYU is skimming off his revenue, but generally it used to be the case that faculty practices are mainly insurance taking--but in the last few years lots of tier 1 faculty practices starting taking cash or only insurance carve outs. JHU is a good example of this: many of their outpatient faculty now only take cash, with rates comparable (perhaps only slightly lower) to the NYC academic groups. UPMC is another example. Academic departments are not dumb. They are creating two tier programs to max out revenue generation. IMO in the last 5-10 years, the number of psychiatrists making 750k-1M+ has increased, potentially exponentially. But the base number is still very low and this market is hard to break into and requires some "connections" and "CV" and magical aura or excellent business acumen or whatever, but it's now at least feasible, and if people tell me this I wouldn't be like you are a f'ing liar. I'd be like, oh ok, yes this makes sense. Good for you. Like @finalpsychyear said if he works 60 hours covering several facilities + part time PP he can pull 750k+ and retire in 10 years. I believe him. I don't want to BE him, never in a million years, but I believe him.

 

[nitemagi]

In my experience, the name of the training program has no value. Do good work and have excellent communication skills.

This. Network. Do good work. Get patients better. Return phone calls. Do what you need to be a great psychiatrist, and forget about your resume.

No one cares about your pedigree.

 

[nebuchadnezzarII]

What do you guys consider "good money?"

 

[Bartelby]

Since we're basically on this topic already, any suggestions for getting connected with this sort of thing outside your geographic region? The typical advice is to network at conferences but in my prior experience (although maybe not close enough to predict for psych job hunting) that has actually been pretty low yield.

I would start with:

1 - Call recent grads from your program in your area of interest.

2 - Let faculty know about your interest and see if they know people / programs to contact there.

You can also cold-call potential employers, they may be happy to see you without a recruiter (though try to know going rates beforehand). Approaching strangers at conferences may work out but having an introduction from someone works much better.

 

[Candidate2017]

OP, this focus on lifestyle and income is misplaced. IM has the same lifestyle options as psych: 7/7, 4 days/week, part-time, call, no-call, outpt, inpt, concierge cash pay ect or combination thereof. Income between IM and psych isn't much different, and IM is greater when you consider it's probably easier to make a high six or seven figure income in IM subspecialties like GI or cards.

Figure out which specialty has BS that you can put up with and do that specialty. Some people think psych sucks, others think IM sucks. Maybe you won't mind sticking a scope up people's butt all day for $500 a pop, or maybe you won't mind listening to narcissists all day for $500/hr. Everyone is different and you'll quickly figure out what you can tolerate once you rotate through them.

 

[nebuchadnezzarII]

OP, this focus on lifestyle and income is misplaced. IM has the same lifestyle options as psych: 7/7, 4 days/week, part-time, call, no-call, outpt, inpt, concierge cash pay ect or combination thereof. Income between IM and psych isn't much different, and IM is greater when you consider it's probably easier to make a high six or seven figure income in IM subspecialties like GI or cards.

Figure out which specialty has BS that you can put up with and do that specialty. Some people think psych sucks, others think IM sucks. Maybe you won't mind sticking a scope up people's butt all day for $500 a pop, or maybe you won't mind listening to narcissists all day for $500/hr. Everyone is different and you'll quickly figure out what you can tolerate once you rotate through them.

Thanks for the advice. I'm trying to figure out which smell I can tolerate more. The smell of poop on the medicine floors or the smell of poop in the psych wards.

 

[Shufflin]

What do you guys consider "good money?"

$400 / hr is pretty good. It's highly location dependent though. I'm in California where COL is high.

 

[nebuchadnezzarII]

$400 / hr is pretty good. It's highly location dependent though. I'm in California where COL is high.

Jesus. I'm happy if someone pays me $100 an hour as long as it's a low-stress job. I think I'm just naive though, from the looks of this thread.

 

[nebuchadnezzarII]

OP, this focus on lifestyle and income is misplaced. IM has the same lifestyle options as psych: 7/7, 4 days/week, part-time, call, no-call, outpt, inpt, concierge cash pay ect or combination thereof. Income between IM and psych isn't much different, and IM is greater when you consider it's probably easier to make a high six or seven figure income in IM subspecialties like GI or cards.

Figure out which specialty has BS that you can put up with and do that specialty. Some people think psych sucks, others think IM sucks. Maybe you won't mind sticking a scope up people's butt all day for $500 a pop, or maybe you won't mind listening to narcissists all day for $500/hr. Everyone is different and you'll quickly figure out what you can tolerate once you rotate through them.

How stressful do you feel is hospitalist medicine vs. outpatient psychiatry?

 

[Shufflin]

Jesus. I'm happy if someone pays me $100 an hour as long as it's a low-stress job. I think I'm just naive though, from the looks of this thread.

My feelings exactly when I was a med student.

I could hardly believe the incomes once out in the "real" world. All kinds of psychiatry out there in all kinds of setups. Look into IM and Psych. Don't worry about stress, focus on fit. Is IM or Psych the better fit. Landing in the wrong fit will create a stressful life.

 

[nebuchadnezzarII]

My feelings exactly when I was a med student.

I could hardly believe the incomes once out in the "real" world. All kinds of psychiatry out there in all kinds of setups. Look into IM and Psych.

Thanks, those are the two specialties I'm considering. Amazing advantage of IM is saving one year. But I don't know if I have the knowledge base or the common sense for the residency and long term career since it just seems too overwhelming. Not sure I'd be able to survive intern year...Psychiatry seems less hands-on which I really like, but the stigma associated with it is the only problem I see.

 

[BiscoDisco]

$400 / hr is pretty good. It's highly location dependent though. I'm in California where COL is high.

This is private practice rates?

 

[TexasPhysician]

This is private practice rates?

Medicine in general has huge variability in pay. I’ve seen psychiatrists excited at $100/hr and a select few earning $700/hr before overhead.

My close friend group of 4 from undergrad are now: child psych (me), IM hospitalist, MFM ob, and a hand surgeon. Who do you think earns the most? It isn’t the hand surgeon even though averages would agree. It’s the IM hospitalist. He is killing it despite normal hours after some promotions, etc. Hand surgeon went academia.

 

[Shufflin]

This is private practice rates?

You can see this in PP and some inpatient jobs. I actually do better than this at my inpatient gig. Prob not TMS or ECT. Def not locums.

 

[ArdorAyurveda]

My close friend group of 4 from undergrad are now: child psych (me), IM hospitalist, MFM ob, and a hand surgeon. Who do you think earns the most? It isn’t the hand surgeon even though averages would agree. It’s the IM hospitalist. He is killing it despite normal hours after some promotions, etc. Hand surgeon went academia.

Which one of you has the most free time to pursue hobbies though?

 

[TexasPhysician]

Which one of you has the most free time to pursue hobbies though?

Probably a tie between me and IM friend. He works 7 on/7 off. His on days are typically 7am-10pm or so. 7 days off is a lot of time to participate in hobbies, but my off time is more evenly spread out.

 

[GEToutLADYits6AM]

Probably a tie between me and IM friend. He works 7 on/7 off. His on days are typically 7am-10pm or so. 7 days off is a lot of time to participate in hobbies, but my off time is more evenly spread out.

Personally I’d rather have my time more evenly spaced out, working 7am-10pm is just restarted if you ask me even if you get 7 days off

#psychisthenewderm

 

[OldPsychDoc]

Personally I’d rather have my time more evenly spaced out, working 7am-10pm is just restarted if you ask me even if you get 7 days off

#psychisthenewderm

Psychiatric hospitalist jobs aren't quite as intense. We work maybe 7:30-5:30 on a REALLY busy day. 9-5 a lot of days. Colleagues who are 7 on/7 off often have PP in their Off weeks, so they aren't showing much evidence of burnout.

 

[nebuchadnezzarII]

Psychiatric hospitalist jobs aren't quite as intense. We work maybe 7:30-5:30 on a REALLY busy day. 9-5 a lot of days. Colleagues who are 7 on/7 off often have PP in their Off weeks, so they aren't showing much evidence of burnout.

How are your colleagues' FT outpatient jobs set up?

 

[GEToutLADYits6AM]

Psychiatric hospitalist jobs aren't quite as intense. We work maybe 7:30-5:30 on a REALLY busy day. 9-5 a lot of days. Colleagues who are 7 on/7 off often have PP in their Off weeks, so they aren't showing much evidence of burnout.

How is the compensation of psychs doing hospitalist jobs compared to normal hospitalists?