Leslie Kane, MA
Executive Editor,
Medscape Business of Medicine
Disclosure: Leslie Kane, MA, has disclosed no relevant financial relationships.
Compare Compensation Across 25 Specialties
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In 2011, psychiatrists earned a mean income of $170,000 -- slightly less than in the previous year. Psychiatrists are in the lower half of compensation amounts among the specialties surveyed. About 6% of psychiatrists earned $300,000 or more – a slightly lower percentage than a year ago. One in 5 respondents earned $100,000 or less, slightly more than in last year's survey.
For employed psychiatrists, compensation includes salary, bonus, and profit-sharing contributions. For partners, compensation includes earnings after tax-deductible business expenses but before income tax. Compensation excludes non-patient-related activities (eg, expert witness fees, speaking engagements, and product sales).
The gap in earnings between male and female psychiatrists has widened. Male psychiatrists reported a mean compensation of $182,000 as compared with $151,000 mean earnings for women. Overall, male physicians across all specialties earn 40% more than their female counterparts, and male psychiatrists earned 20% more than female psychiatrists. According to Tommy Bohannon, divisional vice president of Merritt Hawkins (a physician recruitment firm), more female physicians work part-time, which contributes to an overall lower income.
Psychiatrists in the North Central region (Iowa, Kansas, Missouri, Nebraska, and North and South Dakota) earned the most. However, their mean income of $188,000 represents a decrease from the previous year. The next-highest earners were psychiatrists in the Great Lakes region and the West, both at a mean income of $182,000. Psychiatrists in the Northwest earned the least: $152,000, which represented a decrease from 2010.
Psychiatrists in all settings earned relatively similar compensation, compared with larger variances in other specialties. Psychiatrists in office-based single specialty groups earned the most, at a mean income of $197,000 (similar to 2010). Those in multispecialty groups came in second, at $182,000. Psychiatrists employed by healthcare organizations came in third, at $177,000, while those in solo practice earned $165,000, up somewhat since 2010.
The vast majority of physicians don't consider themselves to be rich, and that's true for psychiatrists as well. Although the public may perceive most physicians as wealthy, only 9% of psychiatrists agree with that characterization. Some 41% said that they don't feel rich because of much debt and high expenses, while one half said that their income is no better than that of many nonphysicians.
The largest percentage (37%) of psychiatrists spends 30-40 hours per week seeing patients -- close to the proportion of 40% in last year's survey. About 36% spend less than 30 hours per week with patients (up from 30% a year ago), while only 2% report spending more than 60 hours per week seeing patients.
The number of patient visits per week for psychiatrists is stable. About 35% of psychiatrists have 25-49 patient visits per week. One quarter of psychiatrist respondents have fewer than 25 visits, compared with 17% a year ago. About 10% of psychiatrists see more than 100 patients per week, also about the same as a year ago.
Due to the nature of the patient relationship, nearly one half of the psychiatrists we surveyed reported visits of 25 minutes per patient or longer -- about the same as in last year's survey. Another one third of respondents have visits of between 17 and 24 minutes. Only 16% of respondents have visits shorter than 16 minutes, roughly the same as a year ago. Many psychiatrists conduct regular 45-minute patient sessions, whereas others do primarily medication management, where visits are in the 15-minute range.
The amount of time per patient visits excludes the patient's time with a nurse practitioner, physician assistant, or medical assistant; it measures only time spent in the presence of a physician.
Paperwork and administrative tasks take up a significant portion of time for psychiatrists. A majority (56%) of psychiatrists spends 5-14 hours per week on paperwork and other non-patient-related activities, about the same as in last year's survey. About 11% spend 25 hours or more per week on these tasks -- a few percentage points higher than in last year's report. Finally, about 17% of respondents said that they spend 4 hours or less on administrative tasks.
Physician frustration is growing. The 2012 report showed far more dissatisfaction among doctors across all specialties. That's somewhat true for psychiatrists as well, but they seemed more contented with a medical career than did the overall group of physicians. About 57% of psychiatrists would choose a career in medicine if they could do it all over again (compared with about 71% in last year's report and with just over one half of all physicians in the current survey). In addition, one half of psychiatrist respondents would choose the same specialty (vs 67% in 2010). Finally, 30% would choose the same practice setting, down from 55% the previous year.
Despite the interest in alternative patient-care delivery models, only a small percentage of psychiatrists are currently involved. About 3% of psychiatrists participate in Accountable Care Organizations (ACOs), but 2% say they plan to in the coming year. Only 1% have concierge practices, while 11% have cash-only practices. Typically, such practices are more often found in primary care than in specialties.
An ACO is a type of payment and delivery model that ties provider reimbursement to quality metrics and reduction in the total cost of care for an assigned patient population. An ACO may initiate bundling of payments for various clinical outcomes. About 3 in 10 psychiatrists we surveyed believe that ACOs will cause a decline in income, while 24% say that they will have little or no effect on income. About 46% said it's too soon to tell.
Elements of healthcare reform entail following treatment and quality guidelines set by insurers and Medicare for shared savings programs, but physicians are clearly skeptical that they will improve patients' quality of care. About 18% of psychiatrists said these measures will lead to better patient care, compared with 25% of physicians across all specialties. About 56% of psychiatrists believe that the guidelines and quality measures will have a negative effect, while 25% said they will have no impact on the quality of patient care.
A majority (58%) of psychiatrists said that they have no intention of reducing the amount of tests, procedures and treatments they perform because they believe the quality guidelines and cost-containment measures aren't in patients' best interests. Almost half (43%) of all physicians agree. Some 17% of psychiatrists said that they won't change their routine because of the need to practice defensive medicine -- a similar percentage as for all physicians surveyed. One in 5 psychiatrists said they would reduce the number of tests and procedures because the guidelines are valid. Another 4% of psychiatrists would reduce tests and procedures because the guidelines will affect their income.
A majority (58%) of psychiatrists said they regularly discuss the cost of treatment with patients, compared with 38% for physicians overall. Another 33% said they occasionally discuss cost of care issues if patients raise the subject (compared with 46% of all physicians). Some 5% never discuss the issue because they themselves don't know the cost of the treatments, while 4% said they never discuss it because they don't believe it's appropriate to do so.
Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey
Disclosure: Mark Crane has disclosed no relevant financial relationships.
