Psychiatrist Incomes Remain Near the Bottom of the Scale

Megan Brooks

April 12, 2017

Psychiatrists continue to rank toward the bottom in terms of compensation for all physicians in Medscape Physician Compensation Report 2017, but nearly two thirds believe they are fairly compensated.

The overall Physician Compensation Report 2017 and the Psychiatrist Compensation Report 2017 were released April 12.

At $235,000 in annual compensation for patient care, psychiatrists came in sixth from the bottom, ahead of infectious disease ($228,000), internal medicine ($225,000), endocrinology ($220,000), family medicine ($209,000), and pediatrics ($202,000).

Once again this year, orthopedists were the highest earners ($489,000), followed by plastic surgeons ($440,000), cardiologists ($410,000), and urologists ($400,000).

Psychiatrists experienced a 4% increase in income this year, mirroring last year's increase. The specialties seeing the largest boost in income were plastic surgeons (24%) and allergists (16%). Pediatricians were the only specialists who reported a decrease in income this year, of 1%.

Gender Pay Gap Persists

The highest-earning psychiatrists practice in the West ($252,000) and the North and South Central regions (both at $242,000); the lowest are in the Southeast ($223,000), the Northeast, and the Northwest (both at $228,000).

Self-employed psychiatrists earn 8% more than their employed peers ($246,000 vs $227,000). This year, as in all previous years' reports, full-time male psychiatrists earned more than their female counterparts ($250,000 vs $212,000), a difference of $38,000.

More than two thirds of psychiatrists say they receive either employer-subsidized health insurance (69%) or paid time off (68%). In addition, 65% get liability coverage, and 59% have employer-subsidized dental insurance. Nineteen percent say they receive no benefits.

Sixty-four percent of psychiatrists feel that they are fairly compensated, up from 58% last year, making them the third most satisfied physician group with regard to compensation. Those who feel most underpaid are urologists (47%), endocrinologists (44%), and nephrologists (41%).

This year, in addition to asking respondents if they are satisfied with their compensation, the Medscape survey asked those who were not satisfied how large an increase they feel they deserve. Forty-seven percent of psychiatrists believe they deserve to be earning between 11% and 25% more, and 9% believe their current income should be increased by more than 75%.

This year, psychiatrist participation in accountable care organizations increased to 24% from 23% in 2016; 3% had concierge, and 13% had cash-only practices.

Of all specialties, psychiatrists were the least likely to say they expect to participate in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect on January 1, 2017.

Nineteen percent of psychiatrists said they would drop insurers who pay poorly, and one quarter said they would not. The question was not applicable to 55% of psychiatrist respondents.

Forty-one percent of psychiatrists said they've seen an influx of new patients during the past year as a result of the Affordable Care ACT, compared with 31% last year. Most psychiatrists (48%) said they will take new Medicare and Medicaid patients and will continue to treat current Medicare and Medicaid patients.

This year saw a notable increase in the percentage of all Medscape survey respondents who say they are participating in healthcare exchanges, at 37%, up from 19% in 2016. Among psychiatrists, 22% said they plan to participate in exchanges, up from just 13% last year; 41% do not plan to participate, which is unchanged from 2016.

This year, nearly three quarters of psychiatrists (73%) said they either regularly or occasionally discuss the cost of treatment with patients; 77% of psychiatrists practicing alone say they charge patients for appointments missed without notice, as do 61% of psychiatrists in single-specialty group practices and 39% of those in multispecialty groups.

About 1 in 5 psychiatrists (21%) spend more than 45 hours each week seeing patients, down slightly from 23% last year.

Patient Relationships Most Rewarding

According to this year's Medscape Lifestyle Report , bureaucratic tasks remain the chief cause of physician burnout, with 56% of all physicians surveyed spending 10 hours or more each week on paperwork and administration, up from 35% in the 2014 report. Slightly exceeding the overall rate, 57% of psychiatrists said they devote 10 or more hours to such tasks each week.

What's most rewarding about being a psychiatrist? Thirty percent cited relationships with and gratitude from patients as the most rewarding aspect of their jobs; 29% cited being good at what they do; 2% found nothing rewarding about their jobs, up slightly from 1% last year.

What's the most challenging part of the job? Nearly one third (30%) chose as the number one response, "having so many rules and regulations." Dealing with difficult patients placed second at 23%.

Still, 82% of psychiatrists said they would choose medicine again if they had to do it all over again, and 87% would choose psychiatry.

Altogether, 19,270 physicians in more than 27 specialties responded to this year's Medscape compensation survey.

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