Psychiatrists Rank in Bottom Third for Income

Caroline Cassels

April 26, 2013

With a mean annual income of $186,000, US psychiatrists are in the bottom third of the compensation ranks compared with other US specialists, according to Medscape's Psychiatrist Compensation Report 2013.

Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.

According to previous Medscape surveys, psychiatrists have historically ranked near the lower end of the income scale, with only slight changes from year to year.

Compared with last year's compensation report, there has been little movement in earnings for psychiatrists. In 2012, 50% of respondents reported that their compensation remained the same as the previous year, compared with 42% in 2011.

Similarly, in 2012, 29% of psychiatrists said that they earned more than they earned in 2011, and 21% earned less; both percentages represent declines from the previous year. In 2011, 38% of psychiatrists saw increased earnings; 19% experienced income declines.

The latest compensation report shows that about 19% of psychiatrists earn $300,000 or more; about 13% earn $100,000 or less. For employed physicians, compensation includes salary, bonuses, and profit-sharing contributions.

For partners, compensation includes earnings after tax-deductible business expenses but before income tax. Compensation excludes non-patient-related activities and includes such things as expert witness fees, speaking engagements, and product sales.

Income by Sex, Location

Regardless of specialty, there is still a large income gap between full-time male and female physicians. Overall, male physicians earn 30% more than their female counterparts. In psychiatry, men earn 20% more than women.

One contributing factor involves women's choice of specialties. There are more women in some of the lower-paying specialties, which skews the overall percentages. For example, 40% of psychiatrist survey respondents were women. By comparison, in pediatrics, 53% of respondents were women; for family medicine, it was 36%.

Psychiatrist compensation also varies by region. Those in the Great Lakes region, who have the highest annual compensation ($247,000), earn significantly more than their colleagues in the Northeast and South Central regions, both earning $181,000.

In 2011, the spread was fairly similar. Psychiatrists earned the most in the North Central region.

As in Medscape's Physician Compensation Report 2012, psychiatrists in office-based solo practices are the top earners, with a mean income of $214,000. This is higher than the figure reported in 2011.

Psychiatrists in single-specialty groups, who are also among the highest earners, also saw an income gain since last year's survey. Psychiatrists working in healthcare organizations also ranked near the top.

Employed physicians earned the same as those in solo practice, although independent contractors earned more on average than both.

Nevertheless, the majority (58%) of psychiatrists feel they are fairly compensated, and compared with all physicians, psychiatrists feel more fairly compensated.

Impact of Healthcare Reform

As with other specialists, the changing healthcare environment has affected psychiatrists. Only 47% would choose medicine again as a career in 2012 vs 57% in 2011.

On the other hand, there were ripples of discontent about practice setting. In 2012, only 23% of psychiatrists said that they would choose the same practice setting, compared with 30% in 2011.

Clearly, there are changes in the way doctors are earning money.

Healthcare reform is having an impact. Psychiatrists saw a big uptick in participation in accountable care organizations (ACOs). In last year's compensation report, only 5% of psychiatrists either participated in an ACO or planned to join one in the coming year. This year it increased to 14%.

Many doctors, worried about potential low levels of Medicare reimbursement, are making the decision to stop taking those patients.

Among psychiatrists, 15% plan to stop taking new Medicare or Medicaid patients, and 7% plan to stop seeing current Medicare or Medicaid patients. Another 34% are undecided.

Workload

The largest percentage of psychiatrists spend fewer than 30 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained constant. In 2012 and 2011, about 36% spent fewer than 30 hours per week seeing patients.

The number of psychiatrists who worked 30 to 40 hours per week was also close (35% in 2012 and 37% in 2011). In contrast, among all physicians, the greatest percentage (30%) worked a 30- to 40-hour week in 2012.

Along most of the time continuum, the number of hours worked were similar from one year to the next. In 2012, 20% of psychiatrists worked a 41- to 50-hour week (in 2011, it was about 18%); 5% worked 51 to 60 hours (in 2011, it was about 8%); and 2% saw patients for 60 hours or longer, the same as in 2011.

The sweet spot for psychiatrists is having 25 to 49 patient visits per week. In 2012, that accounted for 33% of psychiatrists vs 35% in 2011 and about 34% in 2010. The next-largest group — 23% in 2012, 25% in 2011, and about 17% in 2010 — see fewer than 25 patients per week.

Patient loads in excess of 100 patients per week are rare in psychiatry. Only 9% of psychiatrists saw that many patients in 2012; in 2011 and 2010, it was about 10%.

Most jobs entail paperwork and other cumbersome chores, and psychiatry is no exception.

About 20% of psychiatrists spend 1 to 4 hours on paperwork and administration each week, 28% spend 5 to 9 hours, and 26% spend 10 to 14 hours. Only 15% had 20 hours or more of paperwork per week.

Not Just About the Money

But for psychiatrists, it's not all about the money. Being good at the practice of medicine was the paramount reward for 32%; for physicians overall, that number was nearly identical: 34%.

For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among psychiatrists, only 28% felt the same, although it was still second as a factor in career satisfaction.

Good compensation ranked fourth in importance, with 10% of psychiatrists citing it in 2012 compared with 9% for physicians overall.

When it came to pride in being a doctor, the percentage of psychiatrists in 2012 who took pride was slightly less than average for doctors overall: 6% vs 7%.

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