Psychiatry and Money: Is there really a limit?

[ThomasRolland]

Tell me what is wrong with my calculations:

 

Take a basic rate of $200 an hour, which you should be able to pull if you have a good rep in your field. In fact, top psychiatrist can cost a LOT more. Ontario's fee structure lists a one hour psychiatric consult at exactly $200/hour: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html

 

 

$200 an hour x 45 hours per week x 48 weeks = $432k.

 

After overhead, you're looking at somewhere around $400 k.

 

 

 

But we all "know" that psychiatry is a low-paying field. So can someone tell me where the mistake in my calculations is?

 

Thanks.

[Dino]

$32k overhead seems pretty low. Don't you need to pay for staff?

[apache]

you can't see patients for 45 hours a week, believe me, a psychiatrist will work an 8-9 hour day, but a lot of that is doing paperwork and other stuff like phoning primary care docs, writing therapeutic exemptions for patients who can't afford their meeds, connecting patients with resources and a bunch stuff you can't bill for (you're officially supposed to privately bill 185 for a letter of disability so you can qualify for benefits here, but if you're on assisted income you can't pay and most shrinks know that) that but a lot of private psychs have around 4-6 hours of patient interaction a day, so ballpark 800-1200 gross* 250 days a year. Plus the overhead is a bit higher than you're thinking (35 for secretary, around 30-40 for an office...). the big money comes if you think like a dentist and start a mental health clinic, hire counsellors, clinical psychs, reduce overhead and take a cut of their pay for bringing in patients... there's a lot of other creative things you can do in psych, but you have to think outside the box. check out thelastpsychiatrist.com - he has two articles on how to make money in psychiatry.

 

Tell me what is wrong with my calculations:

 

Take a basic rate of $200 an hour, which you should be able to pull if you have a good rep in your field. In fact, top psychiatrist can cost a LOT more. Ontario's fee structure lists a one hour psychiatric consult at exactly $200/hour: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html

 

 

$200 an hour x 45 hours per week x 48 weeks = $432k.

 

After overhead, you're looking at somewhere around $400 k.

 

 

 

But we all "know" that psychiatry is a low-paying field. So can someone tell me where the mistake in my calculations is?

 

Thanks.

[Jochi1543]

Half your patients won't show up, at least that's what my experience has been in the outpatient psych clinics.

[rmorelan]

Half your patients won't show up, at least that's what my experience has been in the outpatient psych clinics.

 

yeah we only got about 2/3 success rate in people showing up

[apache]

sounds about right, that's why i love my add doc, it's like a walk in clinic, i don't even schedule appointments, i just show up and there's always a spot open from a no show, lol.

 

yeah we only got about 2/3 success rate in people showing up

[moo]

Just looking up psychiatrists that I know in BC, they average billings of about 200-300K, which is on par with what I hear.

 

You of course can have medicolegals (I just got slammed with 2 medicolegals yesterday, at 1500 bucks a pop, no overhead, about 3 hours to do each one) and other stuff that can increase your billings, but you definitely can't expect an hourly rate of 200 bucks an hour for 45 hours a week. As someone else said, you need to take time dictating consults, doing paperwork, calling docs, and doing other stuff (like driving from clinic to clinic, standing around waiting for ECT treatment, etc.) such that you won't be "making money" all the time. Even now, I am in clinic, but not seeing patients so I'm technically not making any money.

 

There are also alternative payment plans, but generally those payment plans won't pay you an hourly rate of 200 an hour. If you want money, private practice is where it's at, and you have to be pretty creative in psych or FM or any other "primary care" field to make a ton of money. Not saying it can't be done, but you need to have a business sense of drawing in customers, so to speak.

[bones]

I personally know one psychiatrist, and have second hand reliable information about a second (both in different provinces) who both make significantly more than the average quoted figures for psychiatrists in either province. One of these psychiatrists made seven figures last year, the other stated that he made more than most of the specialists (including surgeons) at the hospital he worked at.

 

As Moo and many others have stated time and again, how much money you make directly doing medicine stuff is a function of efficiency, knowing how to bill, types of work you accept, flexibility, hours worked, private work on the side, etc.

 

I have no idea how these two psychiatrists made so much; one of them does a lot of hospital work, so perhaps that increases his billings. The other one (who made seven figures), I'm not sure how he did it: doing rural tele-psychiatry perhaps? Partnering with community resources like methadone clinics, etc?

 

I think these two psychiatrists are an anomaly, and are certainly at the upper range of psychiatrist salaries. On the other hand, psychiatrists are often called upon to be a part of clinical trials and to consult for drug companies, and this can add tremendous yearly income.

[ghost dog]

Just looking up psychiatrists that I know in BC, they average billings of about 200-300K, which is on par with what I hear.

 

You of course can have medicolegals (I just got slammed with 2 medicolegals yesterday, at 1500 bucks a pop, no overhead, about 3 hours to do each one) and other stuff that can increase your billings, but you definitely can't expect an hourly rate of 200 bucks an hour for 45 hours a week. As someone else said, you need to take time dictating consults, doing paperwork, calling docs, and doing other stuff (like driving from clinic to clinic, standing around waiting for ECT treatment, etc.) such that you won't be "making money" all the time. Even now, I am in clinic, but not seeing patients so I'm technically not making any money.

 

There are also alternative payment plans, but generally those payment plans won't pay you an hourly rate of 200 an hour. If you want money, private practice is where it's at, and you have to be pretty creative in psych or FM or any other "primary care" field to make a ton of money. Not saying it can't be done, but you need to have a business sense of drawing in customers, so to speak.

 

Moo, are you doing medicolegals?

 

Have you taken any disability assessment courses?

Are you certified by CSME?

[leviathan]

How do you get compensated for disability application letters? Do you just charge the patient, or is that hard since they are by definition poor and looking for assistance?

[moo]

How do you get compensated for disability application letters? Do you just charge the patient, or is that hard since they are by definition poor and looking for assistance?

 

If it's a disability tax credit, I often charge the patient or if they're poor and are a patient of mine, I do it for free.

 

If it's an extensive form from the government of BC, there are usually two MSP fee codes for this. One pays 75 bucks and the other pays 130 bucks, and I usually do both of the forms so it pays decently well. (It typically takes no longer than 15 minutes for me to do the two forms)

[moo]

Moo, are you doing medicolegals?

 

Have you taken any disability assessment courses?

Are you certified by CSME?

 

I do medicolegals when they arise.

 

The only disability assessment courses I took was at WCB when I did a rotation there as a resident. They gave me a bunch of textbooks on this.

 

I am not certified by CSME.

[apache]

generally, in psych... you're writing letters for people with schizophrenia (or other severe mental illness) so they can get 1200 dollars a month to live on, people a family doc might be doing letters for people who may have a greater capacity to pay (tradesperson who has lots of money in the bank and is applying for long term disability because of an accident), mostly in psych you're dealing with people who can't pay, and if they're your patient it's sort of hard to say no, so you usually do it for free. my psych has a piece of paper up that sais 185 dollars per missed visit, but it's mostly so new patients who don't know her don't get into the habit of missing appointments, in reality she never charges for missed appointments and instead encourages long time patients to phone or come in to see if there are any missed appointments if they want to see her that day, since there almost always are.

 

How do you get compensated for disability application letters? Do you just charge the patient, or is that hard since they are by definition poor and looking for assistance?

[ThomasRolland]

So let me see if I've understood the field of psychiatry correctly:

 

 

-Low pay

-Ungrateful and potentially violent patients

-Low prestige

-Controversial field ("you're not a real doctor")

 

 

Awesome.

[apache]

nah, you don't really understand anything, psychiatry can be the most heterogeneous field in medicine. especially in the states where you have far more liberty to practice, incorporate cbt, mindfulness meditation, exercise regiments to increase concentration and sex drive, read a ton of behavioral neurology that deals with non pathological states to offer brain wave training and techniques to self modulate mood, attention, concentration, memory, do qeeg with biofeedback, make sure to learn your endo too, that can be a big sell in psych... essentially pitch yourself as a wellness psychiatrist, plus do trad psychopharm and throw in some integrative medicine (n-acetyl-cysteine, inositol etc.) and you've got a recipe for a cash printing machine, and when you don't deal with constructivist pathology invented by drug companies and instead focus on "improvement", which derives its' means from neurology, biopsychology, nutrition, endocrinology, exercise and meditative techniques... youre a suddenly prestigious mental health guru, and your patients are quite pleasant and grateful. people will pay a dermatologist a lot to have an ideal body, but people also want ideal minds... ka-ching... with all the money making idea's i've posted i'm surprised i'm not filthy rich.

 

So let me see if I've understood the field of psychiatry correctly:

 

 

-Low pay

-Ungrateful and potentially violent patients

-Low prestige

-Controversial field ("you're not a real doctor")

 

 

Awesome.

[leviathan]

If it's a disability tax credit, I often charge the patient or if they're poor and are a patient of mine, I do it for free.

 

If it's an extensive form from the government of BC, there are usually two MSP fee codes for this. One pays 75 bucks and the other pays 130 bucks, and I usually do both of the forms so it pays decently well. (It typically takes no longer than 15 minutes for me to do the two forms)

Ohh, ok. My SO always complains because she has to do these for free and the last one took her 8 hours. I'll ask her if she's aware of the 75/130 fees.

[leviathan]

I just finished psych and found there was a lot more medicine than I expected, especially because we have geriatric psych inpatients.

[moo]

Ohh, ok. My SO always complains because she has to do these for free and the last one took her 8 hours. I'll ask her if she's aware of the 75/130 fees.

 

8 hours? It doesn't take me 8 hours to do a medicolegal!

 

I typically have the patient in front of me so they can tell me their situation and the impact the disability has on their lives. Should take no more than 1/2 an hour max.

 

THis is why people need to be aware of these things. If you're wasting 8 hours away doing things for free, it's no wonder people complain about not making any money as a FP.