Psychiatry Job Market

[Candiens12]

How is the psychiatry job market both as an inpatient or outpatient physician?

[ralk]

About as good as you can get in medicine. It's an undersupplied field in most of the country, even major cities have some opportunities.

[BigM]

There is huge demand for psychiatry across the country.  You can definitely establish an outpatient practice anywhere in the country and drum up work fairly quickly.  Unfortunately that doesn't necessarily mean that this is job availability in all hospitals.  It can actually be difficult to get a position in some centers, especially academic hospitals.  I suspect that academic positions are popular because preceptors love to have residents.  Psychiatry residents can for the most part run parallel clinics and run inpatient teams with little supervision and fairly low risk.  This leads to huge boosts in income.  The idea that community physicians make more than academic physicians doesn't appear to hold in psychiatry.

[Candiens12]

Any info on salary differences between outpatient psychiatry and inpatient psychiatry

[BigM]

Most psychiatry is fee-for-service.  Some hospitals, mainly tertiary mental health facilities, do have salaries which are negotiated in your contract.  It appears for these that salaries are similar between those doing inpatient and outpatient.

 

The billing codes for inpatient care pay a bit more than outpatient care (maybe an extra 15-25% but you would need to check the OHIP billing codes to get more accurate).  Appointment no-shows unfortunately are common and can be quite damaging to the income of outpatient psychiatrists.  This generally isn't a problem for inpatient psychiatrists as your patients are there in the hospital are relatively easy to access to see.  An outpatient no-show for a consultation where 90 mins - 2 hours was allocated is a big loss.  In general, inpatient work is higher paying as the billing codes are higher and it is more likely that you will actually get to see your patient. However, this comes at the cost of having significantly less control over your schedule.  You also tend to have sicker patients as these are patients who required an inpatient level of care.  It is difficult to know when you day will end when you are doing inpatient work.  Psychiatry codes are time-based, so if you need to spend a longer time with a patient you get compensated more.  However, you don't get paid for things like team rounds, arranging consults for other services, following up on testing, etc which usually occupy more time from an inpatient practice.

 

Most psychiatrists who work in inpatients will also see outpatients as well.  Unfortunately given the shortage of psychiatrists and long wait lists to access an outpatient psychiatrist, you usually can't just discharge a patient to be followed-up on by another psychiatrist.  If it is felt that a patient needs to be followed by a psychiatrist as an outpatient you usually need to do this yourself.  This can become problematic as you build up a roster of patients that you discharged from the inpatient service (of which there will always be a steady stream of new patients) but have difficulty discharging from your outpatient practice.  Some of the barriers that you run into are that many psychiatric disorders are chronic illnesses, there is a societal expectation that you will follow patients/provide therapy long-term (especially since most social workers, psychologists and other counselors are out-of-pocket expenses), there is a lack of outpatient psychiatrists, the outpatient psychiatrists who do exist usually won't accept a patient who is being followed by another psychiatrists and some family doctors (a minority) can be quick to send a patient back to a psychiatrist after they've been discharged if a medication change is needed or the patient experiences even a slight decompensation.