How much do Psychiatrists really make?

[Mustang92]

In the spirit of the family doctor income post below, I was curious about the realistic earnings of Psychiatrists.
Of course this field shouldn't be entered with a focus on bottom lines but it would be a shame if the income potential was underplayed.
I am interested in the field and have heard from residents that there are opportunities for high income potential that aren't well known at the preclerk level.

If possible any information regarding yearly take-home in the General Psychiatry practices, subspecialties/fellowships and corresponding hours of work would be much appreciated.
Facets such as being a student supervisor, call shifts, split inpatient/outpatient or solely inpatient solely outpatient settings could be expanded on if there is some knowledge there.

Also, what are the private practice models in Canada and how they would influence practice? Although geography would impact income, if we thought broadly by each province and urban vs smaller city vs town, could we group together the financial information on this topic in this thread?

Thanks so much for any and all help!

[MBDTF]

I was told by a staff that with the OMA's recent relativity changes, psychiatrists are getting the second highest increase at 8%? Not sure if someone can confirm that 

[LostLamb]

Inpatient psychiatry in AB does very well. Overall, psychiatry does well in AB.

I wish I could give you everyday numbers but I can't. I know of some who make high 300s and know of some who make 700+ and then there's a few outliers who hit 1M.

Private practise/insurance assessments/lawyer requested assessments are probably the area unknown by preclerks that do extremely well. These folks don't usually take trainees.

 

[Fortress]

On 2/1/2020 at 8:07 PM, LostLamb said:

Inpatient psychiatry in AB does very well. Overall, psychiatry does well in AB.

I wish I could give you everyday numbers but I can't. I know of some who make high 300s and know of some who make 700+ and then there's a few outliers who hit 1M.

Private practise/insurance assessments/lawyer requested assessments are probably the area unknown by preclerks that do extremely well. These folks don't usually take trainees.

 

I am also potentially interested in the field. I was a bit disheartened when I saw that, according to CMA's specialty profile, psychiatrists make a bit less than 300K, which to me doesn't justify the extra years of residency +/- fellowship as compared to family medicine. What do you think of this number? Are the people making 700K sacrificing their work-life balance? Also if you can comment on the current job market for psychiatry as well as the need for fellowship to find a job in an academic center.

[ellorie]

Man I gotta say, a 6 figure income of any kind sounds pretty incredible to me.  I have no complaints whatsoever.  I would say 200-300k is about what you make with a moderately busy outpatient practice, mixed consults and follow up. That’s probably where I’ll be. People who make more work more hours but also probably do more lucrative things - inpatient work, CL tend to make more, ECT can be pretty lucrative apparently, you can also do a high volume of very fast outpatient consults if you know what you’re doing, but I don’t really like to do my consults that way. 
 

Psychiatry isn’t a big fellowship specialty. If you want to work in a big city in one of the Royal College subspecialties (child, geri, or forensics), you most likely need one but otherwise general psychiatry jobs are pretty plentiful. People who want to do CL fairly often do fellowships in the US but you can definitely get hired without. 

[NeuroD]

Psych in Ontario got boosted a few years ago with the mental heth investments. Inga are much better now. And call shifts/locums can be really lucrative. 6-700k is what the ones I know, who work hard, make. That's awesome because a lot of the other traditionally lower billing specialties (neuro, ID, less) can't make that anywhere near that much even of they work hard.

[LostLamb]

I’m in a subspecialty program. I was told the additional RC certificate is 99% required if I ever intended to practise in my subspecialty in Vancouver or Toronto. However, I think with more programs offering the subspecialty training, this will spread to other large metropolitan locations. There is also word that in AB they may add codes for psych subspecialty only, so planning for the extra RC training may be necessary going forward. 
 

average workload/workday should be just under or at 400k (no inpatients). If you work hard/spread yourself thinner/do more lucrative things(ECT, IP) you’ll get into the greater echelon but it comes with a cost to balance for sure—remember, we are a time-based specialty and thankfully can bill as such. 

[Dr. JJ]

2 hours ago, ellorie said:

Man I gotta say, a 6 figure income of any kind sounds pretty incredible to me.  I have no complaints whatsoever.  I would say 200-300k is about what you make with a moderately busy outpatient practice, mixed consults and follow up. That’s probably where I’ll be.

It is nice to see that you still feel this way as a PGY5, instead of having gravitated to "500k or bust!". I also take it that it's helpful that psych tends to have much lower overhead than most fields, although I guess if you're running your own outpatient practice, that would go up a bit? 

All that said, given the five year program, it would be nice if there was at least a little bit of clear daylight between average psych billing and average FM billing. This seems to be the case out West, but perhaps not in Ontario, from the limited, asterisked, years-old data I've seen.* Wish it were easier to get crystal clear info, but with all the variables involved, it seems that will never be the case when evaluating medical compensation!

-JJ

*All I've seen was a chart from like 5 years ago that showed Psych to be within about 1% of FM gross billing, as I recall.

[LostLamb]

Job market remains good. Still jobs in preferred cities, and of course smaller centres and rural sites are desperate for more psychiatrists. 
I don’t see any locums for psych in Alberta; just not a thing that happens here for the specialty. at least at my academic centre there is a big push for more research/clinician scientists and ARP are available to them. Nevertheless, no interest in research is not a barrier and most are clinicians only. 

[ellorie]

I don’t mind being paid the same as FM. What I mind is getting paid like half of what other specialists get while doing work that is equally skilled and difficult.

However as I said, we make good money and I have no complaints on an absolute level. 

[1029384756md]

1 hour ago, ellorie said:

I don’t mind being paid the same as FM. What I mind is getting paid like half of what other specialists get while doing work that is equally skilled and difficult.

However as I said, we make good money and I have no complaints on an absolute level. 

As a FM staff, I also mind getting paid like half of what specialists get while doing work that is often equally skilled and difficult. But it's hard to argue that when my training was only 2 years long. The pay gap used to bothered me, until I stopped doing FM altogether.

[ellorie]

20 minutes ago, 1029384756md said:

As a FM staff, I also mind getting paid like half of what specialists get while doing work that is often equally skilled and difficult. But it's hard to argue that when my training was only 2 years long. The pay gap used to bothered me, until I stopped doing FM altogether.

Yeah I mean sure the training is shorter but does three extra years of staff earning really out balance an entire career’s worth of making significantly less?

I actually think that specialists and family docs should make roughly the same. The disparity for family medicine also makes no sense to me. It’s less formal training but not less highly skilled/valuable. 

[1029384756md]

1 hour ago, ellorie said:

Yeah I mean sure the training is shorter but does three extra years of staff earning really out balance an entire career’s worth of making significantly less?

I actually think that specialists and family docs should make roughly the same. The disparity for family medicine also makes no sense to me. It’s less formal training but not less highly skilled/valuable. 

While I agree that most physicians should be compensated similarly for their time, it's easier to argue for parity when your formal training is 5+ years vs 2+ years. Psychiatrists getting paid much less than other specialists just goes show how much/little mental health is valued by governments. Same with primary care.

3-5 years of 60K vs 300+K earnings in this bull market can be a big advantage for FMs, especially when one discounts future earnings to their net present value.

[1D7]

12 hours ago, PhD2MD said:

That's awesome because a lot of the other traditionally lower billing specialties (neuro, ID, less) can't make that anywhere near that much even of they work hard.

Could be worse. You could be in pediatric neurology (or pediatric most things)!

[blueoval177]

Psych where I'm at.

Salary - full benefits, pension, holiday, sick time - cannot incorporate for this. 7.25 hrs mon-fri

- 315k +  daily call stipend (1/7+) = 360k+ annual (no overhead)

can still have private practice - most guys adding another 100-250+, all depends on lifestyle. So 450-550+ with benefits/pension/holidays. Have to ask an accountant what the benefits is worth but quite a bit with the pension matching. Have to work pretty hard FFS to keep up.

[NeuroD]

26 minutes ago, blueoval177 said:

Psych where I'm at.

Salary - full benefits, pension, holiday, sick time - cannot incorporate for this. 7.25 hrs mon-fri

- 315k +  daily call stipend (1/7+) = 360k+ annual (no overhead)

can still have private practice - most guys adding another 100-250+, all depends on lifestyle. So 450-550+ with benefits/pension/holidays. Have to ask an accountant what the benefits is worth but quite a bit with the pension matching. Have to work pretty hard FFS to keep up.

:O!

 

Prairies?

[blueoval177]

29 minutes ago, PhD2MD said:

:O!

 

Prairies?

You betcha. 

[NeuroD]

4 minutes ago, blueoval177 said:

You betcha. 

Excuse me, I need to catch a plane.

[LostLamb]

On 2/14/2020 at 7:56 PM, blueoval177 said:

Psych where I'm at.

Salary - full benefits, pension, holiday, sick time - cannot incorporate for this. 7.25 hrs mon-fri

- 315k +  daily call stipend (1/7+) = 360k+ annual (no overhead)

can still have private practice - most guys adding another 100-250+, all depends on lifestyle. So 450-550+ with benefits/pension/holidays. Have to ask an accountant what the benefits is worth but quite a bit with the pension matching. Have to work pretty hard FFS to keep up.

which province?

I am thinking MB.

would like to know more about the extras...

[WACOWACO]

Damn....I should have applied to psychiatry....

[-JAG-]

Psychiatry bills an average of 456k in Quebec, where discrepancies between specialist incomes are much lower. Very good group psychotherapy fees (400/hr) Consults and individual psychotherapy fees are decent as well (I think 50$/15 min with the last 5 minutes of the session being eligible for 50$ too, consults vary between inpatient and outpatient, or cabinet, but all this can be found on the RAMQ fee schedule) A couple of outliers in psychiatry in Qc, 10 in 2015 billed more than 1 million, with the average among them being 1.2 million. The best way to achieve this (in my mind) would be to run group psychotherapy at 35 minute intervals billing 300$ for each (minimum 3 patients). Bc and manitoba have decent fees as well (med management for BC and psychiatric care in manitoba which is something like 64$/15 min or major part thereof up to a maximum of 30 minutes with a very vague definition)

[ellorie]

Damn. That’s pretty good. In Ontario, an hour of group pays the same as an hour of individual which is...silly. 

[Hanmari]

1 hour ago, -JAG- said:

Psychiatry bills an average of 456k in Quebec, where discrepancies between specialist incomes are much lower. Very good group psychotherapy fees (400/hr) Consults and individual psychotherapy fees are decent as well (I think 50$/15 min with the last 5 minutes of the session being eligible for 50$ too, consults vary between inpatient and outpatient, or cabinet, but all this can be found on the RAMQ fee schedule) A couple of outliers in psychiatry in Qc, 10 in 2015 billed more than 1 million, with the average among them being 1.2 million. The best way to achieve this (in my mind) would be to run group psychotherapy at 35 minute intervals billing 300$ for each (minimum 3 patients). Bc and manitoba have decent fees as well (med management for BC and psychiatric care in manitoba which is something like 64$/15 min or major part thereof up to a maximum of 30 minutes with a very vague definition)

Interesting. I thought generally speaking doctors made less in Quebec vs. other provinces. Is that not the case for psychiatry then?

[-JAG-]

1 hour ago, Hanmari said:

Interesting. I thought generally speaking doctors made less in Quebec vs. other provinces. Is that not the case for psychiatry then?

I posted the National Assembly's budget earlier today which included average compensation for every specialty, you can see for yourself and compare to the CIHI numbers for other provinces. The basic trend is that all specialists in Quebec basically earn the same thing (500k +/- 10%) bar radiology (850k average) and cardiac surgery (but they work so much so the hourly rates are probably the same) Family medicine does well here too. No FHO but the government basically pays your overhead with the "en cabinet" fees for office visits (+ 30 to 35% for FM visits done in a private office/clinic). Good counselling and workers comp codes as well (you mention STD's or women's health and it's 30$, some CSST forms that take 5 minutes to fill out are 65$ and all that is on top of the flat rate which is around 50$ for a visit in a private office, appointment or not) Basically, if you're a cardiologist, gastroenterologist or nephrologist for example Quebec is not the place to be, but its also the only place you can expect to make close to 500k on average in psych, peds, geriatrics, GIM (well ON and AB do well here too), allergy or EM (numbers for this specialty are hard to come by, but I heard ON and AB do well here too, but QC is still definitely ahead of BC or the maritimes)

[MBDTF]

3 hours ago, ellorie said:

Damn. That’s pretty good. In Ontario, an hour of group pays the same as an hour of individual which is...silly. 

What's the breakdown like for billing in Ontario for in-patient vs outpatient psychiatrists?