Psychiatrists made a little more money caring for patients in 2014 compared with 2013, but they are still among the lowest earners in medicine, according to the Medscape Physician Compensation Report 2015.
Comparing 2014 with 2013 compensation for patient care, psychiatrists reported an increase of 10%. They came in seventh from the bottom, with average earnings of $216,000.
The lowest earners are pediatricians ($189,000), followed by family physicians ($195,000) and endocrinologists and internists (both at $196,000). The top earners this year are orthopedists ($421,000), cardiologists ($376,000), and gastroenterologists ($370,000).
The greatest increases in compensation for patient care in 2014 went to infectious disease physicians (22%), followed by physicians who mostly work in hospitals: pulmonologists (15%) and emergency medicine physicians and pathologists (both at 12%).
At $10,000, psychiatrists are also seventh from the bottom among specialists in compensation for non–patient care. Non–patient care activities include expert witness duties, product sales, and speaking engagements. Orthopedists, who make the most from patient-care work, are also at the top of the list for compensation from non–patient care activities ($29,000).
Satisfaction Levels
According to the report, the highest-earning psychiatrists live in the West ($251,000) and Northwest ($238,000) regions, whereas the lowest are in the Mid-Atlantic ($201,000) and the Southeast ($205,000) regions.
Employed psychiatrists make less than their self-employed counterparts ($204,000 vs $249,000).
This year, as in all previous years of the report, male psychiatrists are earning more than their female counterparts, but female psychiatrists work shorter hours and fewer weeks, which may explain this.
Only 48% of female psychiatrists are satisfied with their income, which is far lower than the rate reported by their male counterparts (61%). Fifty-eight percent of employed psychiatrists feel they are fairly compensated, as do 53% of those who are self-employed.
By setting, psychiatrists in office-based solo practices make the most ($252,000), followed by multispecialty groups ($229,000). Those who earn the least money are in academic or government centers ($188,000) and hospitals ($207,000).
To determine the level of general career satisfaction, Medscape averaged the percentage of psychiatrists who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. At 57%, psychiatrists came in second in overall satisfaction, which is the same ranking and nearly the same percentage (58%) as they reported last year.
According to the calculation, the most satisfied physicians this year are dermatologists (63%), with pathologists tied at 57% with psychiatrists. The least satisfied, from the bottom up, are internists (47%), nephrologists (48%), and general surgeons (49%).
What do psychiatrists find most rewarding about their job? Thirty-two percent of women and 28% of men said relationships with patients are a major source of satisfaction. More men (34%) than women (31%) cited being very good at their job as a reward, whereas more female (17%) than male (13%) psychiatrists named making the world a better place. A discouraged 6% of women and 4% of men found nothing rewarding about being a psychiatrist.
Regulatory Tsunami
Sixty percent of psychiatrists spend 30 to 45 hours per week seeing patients. Far fewer (21%) spend more than that. Paperwork load is nearly equal among self-employed psychiatrists and those who are employed: 57% of those who work for themselves spend 10 or more hours per week on these tasks, compared with 58% of those who work for others.
Despite considerable publicity, cash-only and concierge practices are still not significant payment models for psychiatrists. This has changed little since last year. Participation in accountable care organizations (ACOs), however, continues to rise, from 19% last year to 23% currently, with 4% more expecting to be part of an ACO this year.
The American Medical Association has warned that the "regulatory tsunami" facing US physicians could cut Medicare payments by more than 13% by the end of the decade. Three quarters of employed and only 38% of self-employed psychiatrists said they will continue taking new and current Medicare or Medicaid patients — which is still up from their responses last year, when 59% of employed and only 25% of self-employed psychiatrists said they would take these patients. A small decline was observed in those not taking Medicaid or Medicare.
There was also a larger decline among undecided employed psychiatrists between last year and now, from 33% to 15%, and among those who were self-employed, from 36% to 26%. This decline, coupled with the increase in those taking Medicaid/Medicare patients, suggests that more undecided psychiatrists opted to take these patients.
In a Medscape report on insurers conducted in 2014, well more than one half (58%) of all physicians received less than $100 from private insurers for a new-patient office visit. In the current report, when asked whether they would drop insurers who pay poorly, 22% of psychiatrists said they would and 21% said they would not.
According to Medscape survey findings, 13% of employed and 11% of self-employed psychiatrists say they have offered new ancillary services within the past 3 years. Ancillary services in psychiatry practices can include in-house laboratory services: for example, urine drug screens, fingerstick blood testing of lead levels for children, and rapid tests for respiratory illnesses.
Nearly three quarters (72%) of psychiatrists said they discuss the cost of treatment with patients, although only one third did this regularly.
Only 14% of psychiatrists are planning on participating in health insurance exchanges, which is down slightly from 17% last year. This year, 39% of psychiatrists said they were not participating, up from 32% in the 2014 Medscape report. Only 6% of psychiatrists believe that their income is likely to increase with health insurance exchanges; 21% believe that their income will decrease.
Medscape Medical News © 2015 WebMD, LLC
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Cite this: Psychiatrists Remain Among Medicine's Lowest Earners - Medscape - Apr 21, 2015.
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