Psychiatrists' Pay Increases, Most Happy With Income, Career

Megan Brooks

May 21, 2020

Psychiatrists continue to rank close to the bottom of the compensation ladder, but they made more this year than last year and they continue to enjoy their profession, findings from the newly released Medscape Psychiatrist Compensation Report 2020 show.

Psychiatrists' average annual income this year rose to $268,000, up from $260,000 last year. Two thirds of psychiatrists feel fairly compensated, similar to last year's percentage.

Psychiatrists are below the middle earners of all physician specialties, ranking eighth from the bottom, just below neurologists ($280,000), but ahead of rheumatologists ($262,000) and internists ($251,000).

Orthopedists are the top earners ($511,000 annual pay), followed by plastic surgeons ($479,000), otolaryngologists ($455,000), and cardiologists ($438,000), according to the overall Medscape Physician Compensation Report 2020, which covers US physicians as a whole. The survey included more than 17,000 physicians in over 30 specialties.

COVID-19 Impact

An important caveat is that data for this year's report were collected prior to February 10, 2020, and therefore reflect physician salary and income prior to the COVID-19 crisis, which has had a huge impact on physicians.

For example, since the start of the crisis, data show that physician practices have seen a 55% dip in revenue and a 60% dip in patient volume on average. Hospitals and physician groups nationwide have implemented layoffs, furloughs, and pay cuts.

In March, 43,000 healthcare workers were laid off; 9% of independent medical practices reported that they have closed their practices, at least temporarily.

There continues to be a gender pay gap in psychiatry, with male psychiatrists earning about 21% more than their female peers ($289,000 vs $239,000). Among all specialists, men earn 31% more than women, similar to last year's figure of 33%. There continues to be a 25% gender pay gap among primary care physicians.

Psychiatrists report that they are eligible for $26,000 in annual incentive bonuses. Such bonuses are highest among orthopedists ($96,000) and lowest among family medicine physicians ($24,000).

Close to one third of psychiatrists (and physicians overall) who have incentive bonuses say the prospect of the bonus has encouraged them to work longer hours.

Two thirds of psychiatrists say they receive more than three quarters of their potential annual incentive bonus. On average, psychiatrists achieve 70% of their potential bonus, similar to physicians overall (67%).

However, COVID-19 may change that. Experts recently interviewed by Medscape Medical News noted that productivity benchmarks for physicians are likely to be lowered in light of plunging patient numbers from COVID-19, and bonuses are expected to take a hit. 

Happy at Work

On average, male psychiatrists spend 34.5 hours per week seeing patients, somewhat higher than female psychiatrists (31.5 hours); the average for all physicians is 37.9 hours per week.

Bureaucratic tasks continue to be a burden for physicians in all specialties. On average, psychiatrists spend 15.9 hours per week on paperwork and administration, about the same as physicians overall (15.6 hours).

Intensivists top the list regarding such tasks (19.1 hours), followed by internists (18.5 hours), infectious disease physicians (18.5 hours), and psychiatrists (18.3 hours). Anesthesiologists and ophthalmologists spend the least amount of time on paperwork/administration (10.0 and 9.8 hours per week, respectively).

What is most rewarding about being a psychiatrist? Making the world a better place (helping others) tops the list (28%), followed closely by relationships with and gratitude from patients (24%), being good at what they do/finding answers, diagnoses (20%), and making good money at a job they like (15%). A few cited teaching (6%) and pride in their profession (4%).

The most challenging part of practicing psychiatry is having so many rules and regulations (29%). Other challenges include dealing with difficult patients (18%), working with electronic health records (13%), having to work long hours (11%), and trouble getting fair reimbursement (10%).

Despite the challenges, if they had to do it all over, 81% of psychiatrists would choose medicine as a career again and 89% would choose psychiatry again. 

Other key findings in the latest report regarding psychiatrists include the following:

  • At 16%, psychiatrists rank toward the middle of physicians potentially losing money on denied or resubmitted claims. Plastic surgery and emergency medicine have the highest percentage of claims denied or resubmitted (28% and 22%, respectively). One study found that, on average, 63% of denied claims are recoverable, but healthcare professionals spend about $118 per claim on appeals.

  • Only 14% of psychiatrists say they use physician assistants to treat patients in their practices, while 46% use nurse practitioners; about half (51%) use neither for patient care. Of psychiatrists who work with physician assistants and nurse practitioners in their offices, 34% say these employees have helped boost profitability.

  • 56% of psychiatrists say they will continue taking new and current Medicare/Medicaid patients; only 1% say they won't take new Medicare patients and 22% are undecided.

  • The large majority of psychiatrists rely on payers; 30% rely on fee-for-service arrangements and 14% on accountable care organizations (ACO) for patient-based income.

  • Only 12% of psychiatrists expect to participate in the merit-based incentive payment system (MIPS) and only 1% expect to participate in alternative payment models (APMs).

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