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 ...