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brady23

Why do people say psychiatry is a low paying specialty?

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Their average hourly rate comes to about $200/hour based on OHIP billing

An initial consultation (which may take an hour) is ~$200

Repeat consultations (which may take 30 minutes each), so they can do about 2 per hour is $210

Even with no-shows, you're still making a decent amount of money (and a psychiatrist I was shadowing did say that the no-shows are not that frequent)

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23 minutes ago, brady23 said:

Their average hourly rate comes to about $200/hour based on OHIP billing

An initial consultation (which may take an hour) is ~$200

Repeat consultations (which may take 30 minutes each), so they can do about 2 per hour is $210

Even with no-shows, you're still making a decent amount of money (and a psychiatrist I was shadowing did say that the no-shows are not that frequent)

Depending on the type of psychiatry, you do a lot of calling around collecting collateral, maybe less so in outpatient referral type practices, but definitely alot of that in in patient. 

Psychiatrists i've worked with have said no-shows is actually a decent enough issue for them. Very varied. Depends on patient population your dealing with.

Overhead as well, and less likely to be able to whiz through patients, like a GP could.  But again, very dependent on practice - one psychiatrist i worked with was definitely to the point and quick (not doing a great job in my opinion).

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Most of the academic ones I've worked with equal their IM colleagues in pay. The ones who aim to make bank surpass their surgical colleagues. Jobs are plentiful currently. The workload in residency is much lighter when compared to almost any other specialty. And of course, you rarely have any need to rush or hurry anywhere.

As for why it has that reputation - I suspect certain subspecialties and outpatient psychiatry is compensated relatively poorly in comparison, which drags down the average. The field also attracts personalities that are less likely to grind for hours and days on end.

Overall it's a fantastic career if you enjoy the nature of it and have the right personality. If compensation is your primary concern, psychiatry remains a great specialty.

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6 hours ago, 1D7 said:

Most of the academic ones I've worked with equal their IM colleagues in pay. The ones who aim to make bank surpass their surgical colleagues. 

But you are comparing a psych busting their ass to an average run of the mill surgeon. I bet if you compared them to a surgeon out to print cash it might be a different story. 

Most of the psychiatrists in my province that I know seem to be on salary. I know of a couple who are FFS and do lots of inpatient work. They seem to be well compensated. 

I agree that if you are able to enjoy working as a psych, its a great career. 

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A consultation in sum total takes more than an hour for most people - for a complex patient you may need to bring them back, and it also takes time to do a decent/thorough consult note, as well as calling for collateral.  The documentation takes up a lot of time in psychiatry.  Additionally, most of my mentors say that they see fewer patients in a day just because of the emotional drain and how mentally taxing it is.

If you want to make a ton of money as a psychiatrist, you probably can.  ECT is quite lucrative, emerg work, other things with premiums.  It's not like we don't make money.  We make very decent money, so it's not absolutely low paying.  But the average psychiatrist typically makes less than the average [some other thing].  We don't have a lot of procedures that can bump income, documentation takes a long time, and there's a particular mental drain that makes it really difficult to just grind through endless numbers of consults.  Also the no show rate does depend on your practice setting and can be quite high.

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Each province has some nuances to billing that can make a difference inter-provincially. 

I suspect, as well, that certain positions in certain provinces compensate better than others. 

In contrast to NLengr’s province, few to none of the psychiatrists in my province are salaried and definitely don’t want to be. 

Youll make bank if you work for it—but it’ll come at some other cost. 

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its a vestige of american-centered thinking in medicine- in US, psych is definitely under-paid, mostly because the surgeons/private practice make obscene amounts of money there. The situation is much different here given our funding/billing structure.

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3 minutes ago, Hellothere77 said:

https://www.cma.ca/En/Pages/specialty-profiles.aspx

 

2015/2016 average gross for psychiatry was 260k, for Internal (including sub-specialties) 400k, for peds 300k, all similar overheads

Based on that the reputation is understandable, especially when the training is 2.5x longer than FM

I think the idea is that the average is far less generalizable in Psychiatry than it is in other specialties. Much like family, psychiatry tends to be a lifestyle specialty with many people working less than full time. There's another thread about how much an internist can make on an overnight shift. Last time I spoke to a psych resident they were giving me similar numbers of 3-5k per night.

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2 hours ago, Aconitase said:

Anything less than 500k per year (after overhead) is a lower paying speciality. Most of what we call high billing ones are well over this. Psych is likely below

but the majority of specialties after overhead are well below 500K. Even more will be after the next round of adjustments as well. That is a pretty high bar you are setting there. 

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19 minutes ago, rmorelan said:

but the majority of specialties after overhead are well below 500K. Even more will be after the next round of adjustments as well. That is a pretty high bar you are setting there. 

A lot are well over 

 

-radiology

-radiology

-GI

-nephro

-optho

-cardio

-vascular surgery

-cardiac surgery

-neurosurgery 

 

Did I mention reds? 

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11 minutes ago, Aconitase said:

A lot are well over 

 

-radiology

-radiology

-GI

-nephro

-optho

-cardio

-vascular surgery

-cardiac surgery

-neurosurgery 

 

Did I mention reds? 

I mean you aren't way off in left field there. Breaking it down: 

Gross billings in 2014/2015 for those according to the auditor general - the median values with in brackets the 90 percent level

GI 532 (904)

radiology 580 (1041)

-nephro 524 (892

-optho 553 (1266)

-cardio 526 (991)

-vascular surgery 556 (912)

-cardiac surgery 525 (898)

I will add

thoracic surgeon 540 (892)

with neuro surg is more complex I guess - it pays a lot less than people usually think, although again there are some high billers there. 

-neurosurgery 406 (913)

to complete the set of all doctors with median (before overhead) billings on average using median as the measure over 500K. After overhead the median of course would fall for many of those to below 550K. The auditor general also reports those number would be roughly 40K higher if you use straight up average. We have had a few cuts since 2015, more on the way and many of those above are also going to be re-balanced. Which is drop many of those you mention by 30% effectively by the time any premed here actually becomes staff. 

Now you can definitely push to be on the higher side of average - and those field do pay well even though they will pay less going forward. But I guess my point overall was  - the complete sum of all those doctors is what (?) 10% of all doctors? The majority of those as well  - using either median or straight up average after overhead will earn less than 500K. Nothing stopping anyone from working to be on the higher side of those of course - average is just average after all. But to put the bar at 500K means lets say 80-90% of all doctors are lower paid, and most of the people the list still take home less than 500K after overhead (either by average or median). 

Also many of those higher billing ones - particularly on the high side are ones that have huge overhead - that is why they are billing so much they are billing the government for the equipment and staff they employ. We are talking 50% overhead type ranges in many cases so the numbers are a bit misleading. 

Again doesn't mean that you are in those field you cannot do what ever is necessary to be on the higher side. But it will be progressively harder and harder to do that going forward after the corrections that are now upon us.

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3 hours ago, member_225 said:

When are the adjustments happening and is it for sure? 

Well the OMA passed their motion on it internally last Sunday so from that side it is real. Next we have to see what the government comes up with during arbitration at this point. The OMA deal is basically the the best possible outcome. The government can easily make it worse. 

As for when they will happen the answer would be slowing and starting basically now. 

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4 hours ago, rmorelan said:

I mean you aren't way off in left field there. Breaking it down: 

Gross billings in 2014/2015 for those according to the auditor general - the median values with in brackets the 90 percent level

GI 532 (904)

radiology 580 (1041)

-nephro 524 (892

-optho 553 (1266)

-cardio 526 (991)

-vascular surgery 556 (912)

-cardiac surgery 525 (898)

I will add

thoracic surgeon 540 (892)

with neuro surg is more complex I guess - it pays a lot less than people usually think, although again there are some high billers there. 

-neurosurgery 406 (913)

to complete the set of all doctors with median (before overhead) billings on average using median as the measure over 500K. After overhead the median of course would fall for many of those to below 550K. The auditor general also reports those number would be roughly 40K higher if you use straight up average. We have had a few cuts since 2015, more on the way and many of those above are also going to be re-balanced. Which is drop many of those you mention by 30% effectively by the time any premed here actually becomes staff. 

Now you can definitely push to be on the higher side of average - and those field do pay well even though they will pay less going forward. But I guess my point overall was  - the complete sum of all those doctors is what (?) 10% of all doctors? The majority of those as well  - using either median or straight up average after overhead will earn less than 500K. Nothing stopping anyone from working to be on the higher side of those of course - average is just average after all. But to put the bar at 500K means lets say 80-90% of all doctors are lower paid, and most of the people the list still take home less than 500K after overhead (either by average or median). 

Also many of those higher billing ones - particularly on the high side are ones that have huge overhead - that is why they are billing so much they are billing the government for the equipment and staff they employ. We are talking 50% overhead type ranges in many cases so the numbers are a bit misleading. 

Again doesn't mean that you are in those field you cannot do what ever is necessary to be on the higher side. But it will be progressively harder and harder to do that going forward after the corrections that are now upon us.

Thanks for the breakdown. 

 

Overhead is variable also. 

 

Rads for instance pays next to nothing if hospital based. GI pays a lot if one owns a scope clinic  

 

Maybe 500k pre overhead makes more sense. 

 

Also certain specialties are not listed by anyone (Ie ICU) since it’s not given it’s own billing but those guys bill a lot with no overhead. 

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4 hours ago, rmorelan said:

I mean you aren't way off in left field there. Breaking it down: 

Gross billings in 2014/2015 for those according to the auditor general - the median values with in brackets the 90 percent level

GI 532 (904)

radiology 580 (1041)

-nephro 524 (892

-optho 553 (1266)

-cardio 526 (991)

-vascular surgery 556 (912)

-cardiac surgery 525 (898)

I will add

thoracic surgeon 540 (892)

with neuro surg is more complex I guess - it pays a lot less than people usually think, although again there are some high billers there. 

-neurosurgery 406 (913)

to complete the set of all doctors with median (before overhead) billings on average using median as the measure over 500K. After overhead the median of course would fall for many of those to below 550K. The auditor general also reports those number would be roughly 40K higher if you use straight up average. We have had a few cuts since 2015, more on the way and many of those above are also going to be re-balanced. Which is drop many of those you mention by 30% effectively by the time any premed here actually becomes staff. 

Now you can definitely push to be on the higher side of average - and those field do pay well even though they will pay less going forward. But I guess my point overall was  - the complete sum of all those doctors is what (?) 10% of all doctors? The majority of those as well  - using either median or straight up average after overhead will earn less than 500K. Nothing stopping anyone from working to be on the higher side of those of course - average is just average after all. But to put the bar at 500K means lets say 80-90% of all doctors are lower paid, and most of the people the list still take home less than 500K after overhead (either by average or median). 

Also many of those higher billing ones - particularly on the high side are ones that have huge overhead - that is why they are billing so much they are billing the government for the equipment and staff they employ. We are talking 50% overhead type ranges in many cases so the numbers are a bit misleading. 

Again doesn't mean that you are in those field you cannot do what ever is necessary to be on the higher side. But it will be progressively harder and harder to do that going forward after the corrections that are now upon us.

Do you have a link to these data? When I tried to find something more specific than the superficial breakdown I linked I wasn't able to, I'd be very interested to check that out for other specialties as well

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1 hour ago, Aconitase said:

Thanks for the breakdown. 

 

Overhead is variable also. 

 

Rads for instance pays next to nothing if hospital based. GI pays a lot if one owns a scope clinic  

 

Maybe 500k pre overhead makes more sense. 

 

Also certain specialties are not listed by anyone (Ie ICU) since it’s not given it’s own billing but those guys bill a lot with no overhead. 

yeah the break of overhead is always a problem - I would love to see the billings not just by gross but also by professional vs technical fees - because in many cases those technical fees are really outdated at this point and they inflate everything so much. We are always getting hit on the head about them - but it isn't the fault of the guy that owns a US clinic with 10 sonographers, couple of front line office staff and someone to manage all the billing and HR requirements for all that that he/she is billing so much as an example. You have to shell out that kind of money to run a clinic. They overhead easily can be way over 50 or 60 percent. 

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