Wednesday, January 7, 2009

How Much is a Psychiatrist Worth?

As I've thought about some of psychiatry's recent pharmaceutical research scandals, the broader role of money in medicine has naturally come to mind. After all, there is no way to be totally free of conflicts of interest. Any physician in private practice, or any physician who gets credit of any kind for sustaining a volume of clinical work (such as in academia, where physicians often are salaried but must accrue billings to justify that salary from year to year) has an interest in providing services that may conflict with doing what is medically and ethically justified.

The old joke goes that if you walk into a barbershop and ask if you need a haircut, chances are the answer is going to be yes. But we hold physicians to a higher standard than barbers; even when a surgeon or a psychotherapist could use the business, if a procedure is not indicated in a certain case they are obviously expected to honestly say so, despite their own pecuniary interest. Needless to say it doesn't always play out that way.

According to a list I randomly looked up, the average psychiatrist income in this country is $134,000 (I don't know how specifically reliable that particular survey is, but all the figures are on par with other surveys I have seen various places in the past). In terms of all specialties psychiatry is at the low end, but it is comparable with the other office-based, non-procedural specialties. As this list notes, many physicians put in well more than 40 hours per week, including night and weekend hours.

Perhaps it is puritanical of me, but even apart from the general corruption of psychiatry's already fragile knowledge base that I've already written about, I have also been bothered by the sheer tackiness of psychiatrists augmenting their income in a big way essentially by auctioning off their degree-related expertise to the highest bidder (that is, by giving highly lucrative "educational" talks or obtaining drug company research funding that is more about funding than about research).

Obviously physicians should be and will be paid well in the overall scheme of things. It is a demanding and stressful profession requiring prolonged (7-12 years depending on specialty, usually 8 or 9 for psychiatry) education and training beyond an undergraduate degree. And nowadays medical students often graduate with over $100,000 in student loan debt.

A medical degree is earned through a great deal of hard work, but it is also a privilege granted by society for the general health and welfare, not for the enrichment of individuals. Physicians obviously live comfortably, but the great majority of them are not CEO's-with-three-homes-and-a-yacht kind of rich (maybe a nice home, a superfluity of books, a menagerie of high-maintenance pets, and a canoe).

Some people seem to think it's obscene for a baseball player or a rock star to make many millions of dollars, but in a capitalist society one can hardly object. If one is providing entertainment or any other discretionary product, then one deserves whatever income one can pry out of the market. But short of high-end psychoanalysis and cosmetic procedures, health care is not a discretionary product, unless life itself is discretionary.

Some of the high-profile academic psychiatrists who have generated the recent opprobrium (detailed in the link in my post two days ago) earned seven figures over several years from drug companies, above and beyond their already hefty clinical and academic reimbursements. In a field that, due to the potentially devastating effects of mental illness, frequently serves the most socioeconomically dispossessed members of society, that strikes me as being unseemly. For individuals making six figures to have fancy meals bought for them by drug companies soliciting their services seems to me to be in equally poor taste.

Any opinions out there--do psychiatrists and other physicians make too much money, too little, or just right?


rvitelli said...

I'm not sure that the size of the income matters as much as whether the professional violated professional ethics along the way.

Dr X said...

Oh, goodness, not enough money. I'm not a physician, but people have no idea of the work, the training, the cost and awesome demands of the job. $134,000 for a psychiatrist, is paultry compared with what a modern exec makes.

Dr X said...

Paltry, sheesh! Physicians have to spell correctly, too.

Anonymous said...

No, $134,000 is poultry! I think psychiatrists deserve a much meatier sum than that. I mean, despite all the professional mental housekeeping you'd expect them to do in the interest of sanity, how can they not absorb and assimilate some of the crap they have to endure? --you'd have to be unhumanly bulletproof to have the stamina to be able to deflect everything.

How much is a saved life worth?

If a physician or psychiatrist has the foresight and skill to manifest positive life changes in a patient who would've otherwise rotted in some kind of misery, isn't that considered an invaluable service?

On the other hand, a physician who intentionally does the dirty, selling his/her soul for the price of a fine wine to rinse his/her cheap palate with, probably deserves @#$!-all...

Maybe, unethical psychiatrists begrudge the type of people they're forced to deal with daily, and so regard the bonus asides as just deserts....kind of like 'dirty money' given in exchange for cleaning up the 'filthier' elements of society.

Retriever said...

..Depends on the cost of malpractice insurance and housing where they practice.

It isn't just what they're paid, but what they specialize in. And the ghastly shortages of psychiatrists in some specialties that are risky and the worst paid (I believe). For example, one reads books on pediatric mental illness that talk about how to pick the best child psychiatrist or psychologist, but when the kid is actually psychotic, violent and suicidal you find that there is maybe one doctor in fifty miles brave enough to let them in their office, and they are in a clinic. That rations care and won't even let you pay retail to get the child more care, when they need it. In effect, we now have socialized medicine for severely disturbed kids and chronically mentally ill adults and it sucks. Not because of the practitioners but because of the rationing.

I don't understand what that says about our supposedly child loving society. Or our Judaeo Christian compassion for the sick and suffering.

flawedplan said...

the type of people they're "forced to deal with daily?" Forced, for real? Pot meet kettle anonymous.

I'm the "type of people" psychiatrists choose to deal with daily and you're not even close.

I want a war between the rich and the poor.

Anonymous said...

Novalis for President! Really enjoy your blog posts and your general philosophies. $134,000 seems like a fair salary for a young (new)psychiatrist. It's important work.

Novalis said...

Aw, shucks. Now how do I get your check to you? (There's always money in the budget for extravagant praise).

Wait, you're not that facetious Anonymous, are you?

Anonymous said...


Psychiatrists don't necessarily 'choose' which patients they treat --that would be superficial discrimination, and contradictory to the ethos of why they decided to practice in the first place.

ANd, when I said 'people they're forced to deal with', I'm actually not casting any nasty aspersions about the patients themsleves. Obviously, I'm intimating the possible perspective UNETHICAL PSYCHS unconsciously/consciously subscribe to.

I think most people aren't so ignorant as to not understand that patients vary with geography/socioeconomic class. Working class area psychs don't treat the same types of patients/disorders as others practising in predominantly white upper middle class suburbs plagued with stay at home mums driving their spoilt kids around the corner to school.

I want a war between thoughtless ignorance and open-mindedness.

Anonymous said...

and I mean SUV driving mums - a very different breed indeed...

Anonymous said...

Where's my canoe?????
Dr Ab Snopes

Anonymous said...

Not facetious-captivated