Tuesday, May 3, 2011

The $175,000 Question: Do Psychiatrists Earn Their Keep?

According to an April 28 Medscape survey of 15,000 US physicians across 22 specialties, psychiatrists earned $175,000 in 2010, one of the lowest-paying fields in medicine, little better than pediatricians at the bottom and half as much as top-earning orthopedic surgeons at $350,000. Only about two percent of psychiatrists earned $500,000 or more, in contrast to more than 20 percent of their counterparts in orthopedics.

Lest you think psychiatrists are getting a raw deal, Salary.com reports that the median yearly income for a PhD psychologist is $82,000. Meanwhile, Payscale.com reports the yearly salary range of an MSW psychotherapist at $44,000-$65,000. Maybe this is why more psychiatrists than orthopedic surgeons in the Medscape survey reported feeling their compensation was fair (58 percent vs 47 percent).

According to the Medscape survey, most psychiatrists see patients less than 40 hours a week (with a quarter putting in at least 15 hours a week on paper work), but patient loads of 50-75 visits a week are not uncommon, especially for psychopharmacologists. About half reported seeing patients for 25 minutes or longer. The rest saw patients for less than that.

Do psychiatrists really spend that much time with patients? A NY Times article (reported on this blog) from early March, citing the case of one beleaguered psychiatrist, gives a far different impression:

Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. ... Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

But Medscape sees a dangerous trend, as well. Citing Nassir Ghaemi, MD of Tufts University:

This kind of setup ensures that drugs will be given for symptoms, which is all one can do with quick appointments, as opposed to using drugs to treat diseases, not symptoms, as I recommend and as is part of the Hippocratic tradition. Identifying diseases that underlie symptoms requires longer and more careful evaluations than I fear the average psychiatrist gives the average patient.

Which leads to the $64,000 - no, make it $175,000 - question: Never mind their education and training and the work they put in - in terms of the actual service they provide and the results they achieve, do psychiatrists actually earn their keep?

You tell me ... 


Tony Previte said...

Nope. Why should somebody get paid to listen to you and then do exactly what you ask them to do?

Sounds like the job description of a McCaw to me. ;-)

Anonymous said...

I have heard psychiatrists who said that they did not spend as much time with their patients as they would like because of government CYA paperwork and the requirements imposed by health insurance companies. Some will compare themselves to galley slaves chained to their stations, unable to leave even if their ship were sinking.

Charles Sakai

Anonymous said...

As Charles pointed out, the new system in which patients are herded like cattle through cursory 10 minute medication checkups is a response to insurance payouts.

Seeing four patients in an hour instead of two is simply more profitable, and we don't need Ayn Rand to tell us what will happen when people are faced with the prospect of providing a better service or making more money.

Are psychiatrists worth 175k? Absolutely. Just not how most are operating now. Change the payouts and outcomes will improve.

John McManamy said...

Hey, Charles. Who wants to be a galley slave, even one who gets $175,000? In theory, psychiatry should be one of the best jobs in the world, as well as one of the noblest callings. In practice, it doesn't work out that way.

Tony the cretin said...

In all, I am happy with my psychiatrist. He sees me for 30 minutes which gives me plenty of time to raise concerns and problems. I pay him for visits and then get reimbursement from insurance (a simple form to fill out - 5 minutes of my time). My only complaint is the long commute to get to him, but it is worth it for the time he gives me.

Lizabeth said...

The first psychiatrist I saw was an absolute angel and I think she saved my life. I NEVER spent less than 30 minutes with her and I think she often told insurance companies where to get off. Of course, she treated ALL her patients this way which sometimes made for long waits in the waiting room but it was worth it. She went into medicine later in her life and knew her own priorities and values beforehand.
My second one obviously followed the insurance time shedule but she was very, very, good at prescribing and always available in emergencies.Big problem with her---we lost our health insurance when husband was laid off, no insurance=no care. I think she needs to reconsider how much the establishment has coopted her but that does not change her skill level
The third (we moved for hubby's new job)I had a hard time with because he came across as a salesman. But he did know how to assess problems.
Now I see a psychiatric Nurse Practioner. She knows her stuff and knows when to consult someone. She is always available in an emergency too. She was also one of the two people who spotted my dysphoric hypomania and changed my diagnosis.
In my opinion, they all earned their money. The insurance industry and accountants have far too much influence in ALL areas of medicine.
The ortho-neuro surgon who repaired my husbands C-spine (neck) last spring earned every cent too. Failure would have meant my husband would have been a quadraplegic at best.
Some people we pay with money but really the good ones are beyond price.

John McManamy said...

Hey, Tony and Lizabeth. So glad your experiences were good ones. The 30-min minimum visit comes in loud and clear.

Anonymous said...

Hello John,
Invariably as ever your post strikes such a resonance in relation to own experiences with the psychiatric profession and attempts to decode its
disconnection as I have experienced it in my own rite and as carer to one of my parents (re "dementia") and their experience.

My witness, of debasement of medical ethic, has been such that relativity breaks down and only absolutes seem appropriate … that is to say if only both myself and my parent had never crossed paths with the profession, to have been spared the regressive attrition that has haunted us.

A number of your previous blogs in this arena came to mind … eg comparative levels of quality control in other fields (being higher)… that psychiatry is good at mitigating a crisis but not with aiding recovery ……

I can relate to the galley slave analogy, there are certainly external distorting pressures bearing down upon psychiatrists be it current medical 'orthodoxes', political and economic agendas whether private or public sector.
But then I am also of the opinion, as you put it John, that "Who wants to be a galley slave, even one who gets $175,000? In theory, psychiatry should be one of the best jobs in the world, as well as one of the noblest callings". But as you say "In practice, it doesn't work out that way."

In a light moments I have often reflected the biggest achievement of those I have encountered was to have completed their medical qualifications and the ~£80,000+ they bag with it not to mention the individual and collective hubris with which their field appears to be imbibed.
Certainly there are honorable exceptions who do stand up firmly above the parapet but sadly the only seem to exist in relative isolation.

The most truely damaging is to be on the receiving end of a top down determinist medical 'engagement'…in that there is no good future. Only a mutual relationship has any constructive future, I would suggest.

Apologies for length of comment.

John McManamy said...

Hey, Neil. "Top down determinist medical engagement." That says it all. :)

Anonymous said...

I've worked in 3 different MH agencies, currently in one now, and I've been a patient of many many more. The longest a psychiatrist saw me OR sees anyone is 30 minutes. That is usually the 2nd visit.

The 1st visit, the Psychiatric Evaluation, the visit that determines what is wrong with you and how he/she has sized you up and how he/she thinks you should be handled... 45 minutes. The 2nd appointment, 30 minutes. Every appointment afterward... 10-15 minutes and you don't go over.

Course, I work in and I attend those agencies of indigent patients. You know.. the ones with no insurance, sometimes no homes, and many are on the government rolls.

Large substance abuse, large chemical abuse, large domestic violence, many are repeat hospitalizations... all because they come in (including me at times) to get one thing.. meds. Meds are given quite freely. The appointments are all about the meds. Meds meds meds meds meds. They'll appear or call for the meds.

The psychiatrists I know.. are there for meds and meds only. Outside of meds, you are either totally on your own or you go visit a social worker and/or therapist. You want a med for your anxiety or anger.. you go see the doc. Meds baby.. that's all it's about.