Which subspecialties of psychiatry pay the least/most?

[WisNeuro]

It’s also interesting the things that require capacity, and those that don’t - ie matrimonial capacity is a thing, but parental capacity is not. I don’t suppose they cover that in the fellowship?

It's a different legal issue. By and large, capacity/competency issues deal with having capacity to make decisions for the self, not others. Custody cases are a whole different ballgame.

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[psyguru]

Stop the chicken little thing about NPs. They are no more threatening to us than primary care efforts to manage psychiatric issues and in many cases not even as good at it.
I have always heard that forensics is the highest paid subspecialty in psych. I'm sure it depends on reputation and how aggressively you market. Forensics and Child are about the only two subspecialties where you really need to do the fellowship to practice it, and I'm not so sure about forensics. I guess sleep and pain are also fellowship musts. CL, addiction, geriatrics, and the numerous other non-accredited fellowships really don't. My 2 cents is that fellowships do help and it is nice to know what you are doing however.

I agree regarding forensics. About every 40 hours invoiced is 10% of my clinical salary. In clinical practice you are incentivized to keep the interview short. The opposite is usually true as an expert witness unless your hours are capped in IMEs or some criminal cases. However in many med mal or wrongful death cases there is no interview. It is worth doing the fellowship in my opinion.



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[psyguru]

I agree with this.

It takes longer to build a good forensic practice than a good private practice, and the work is unpredictable. You get a nice wage. It's not hard to get $300-$600/hour, with criminal cases on the lower end of the scale and civil work on the higher end.

But this is almost impossible to pull off full-time. Aside from the scheduling issues, you get good pay by doing good work and the WORST forensic psychiatrists are those who don't maintain clinical skills. Their work is shoddy and they tend to be bottom feeders, which is great for a quick buck but they typically find it harder to get decent (i.e. higher paying and higher hours) cases due to reputation. The best way to make a decent living in forensics is to maintain a paid faculty appointment, but it's tough finding one that is compatible with taking frequent time off to meet with lawyers and testify in court.

Regarding getting time off, most employers I've talked to indicated that any time away is vacation time. The only time I testify in court without taking the day off (or comp time) is if I'm subpoena'd as a fact witness, NOT for my forensic practice. And if you get a faculty appointment, many places will charge you a 15-25% fee for any forensic work you do on your off hours (although in these cases, they'll also often help with billing, office space, and malpractice). And some places will have you sign a contract forbidding that you do forensic work on your off hours (I'm looking at you, Kaiser).

I definitely make a higher hourly rate as a private forensic psychiatrist than I could make in any other area of psych. But I definitely can't multiply my hourly rate by 40 and call myself done.

My previous faculty job took 50% and that is why I left. If you invest in good marketing, you could develop your forensic practice faster. I invoiced about 80 hours last year and I finished my fellowship about 3.5 years ago. This year I plan on doubling that. I have increased my rate as well. I plan on getting rare certifications to develop a niche.

In forensics you don't have to worry about NPs. Only cases they can get really is med mal cases involving mid levels.

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