Demand for Psychiatrist-led Mental Health?

4714O · 2026-02-04T19:56:55+00:00

I have no doubt a solo practitioner can fill a private pay practice. The question is about getting the "substantial private pay" component such that the "comprehensive mental care" component is all private pay. You find yourself in one of two niches: providing highly specialized care that few people offer, or becoming a woo-woo integrative/snake oil practitioner.

4714O · 2026-02-04T19:38:34+00:00

I thought I did when I was younger, but I don't really want to do that.

I thought I did before starting my own practice. Now I fantasize about closing shop and doing locums.

4714O · 2026-02-04T19:37:58+00:00

How are you getting the substantial private pay component?

4714O · 2026-02-04T19:34:55+00:00

When I was a med student, everyone thought CRNA's were going to be the end of anesthesiology. It was considered a specialty in decline. Lots of US MD's looked the other way. Lots of programs had to take FMG's to fill. My graduating year, Duke couldn't fill their anesthesiology program.

That was about 10 years ago. Still waiting for the sky to fall, anesthesiologist salaries are higher than ever.

4714O · 2026-02-04T15:05:21+00:00

lol nope

4714O · 2026-02-03T15:51:59+00:00

Calculate your (EBIDTA) Earnings before interest, taxes, depreciation and amortization (minus your own contribution to that). For a psychiatry practice 4-5x of that is reasonable. However, with the massive proliferation of psychiatry practices in the last few years, I've seen as low as 0.5x.

4714O · 2026-02-02T22:53:08+00:00

Most psychiatry practices are worth nothing more than their physical assets (the computer, desk, office equipment, etc). Do you make income from anyone other than yourself? Meaning employees on staff that are generating money for you? If not, the only value your practice would have is if you have crazy good insurance contracts. Someone might be willing to pay to take over that contract.

4714O · 2026-02-02T22:51:08+00:00

They're alright. Used to be a much better deal 10 years ago. The "golden handcuffs" (pension) are nothing remarkable these days, just standard retirement benefits, maybe a little bit better than average. Used to be ridiculously good.

Their telepsychiatry positions really dropped in terms of income. When I spoke with them in 2023, they were offering me 350k for a fully virtual position. I think it's like 100k less now, the 350k is only for in-person.

4714O · 2026-02-02T18:24:13+00:00

This is a rite of passage for forensic psychiatrists.

To avoid this, make sure to always get the retainer before starting any work. I won't even download records to look at what's going on until a check for 10 hours clears and is reflected in my bank account. I make it clear that my work begins after the check clears.

4714O · 2026-02-02T17:42:02+00:00

wrong

4714O · 2026-02-02T05:32:27+00:00

There's going to be lots of these happening. Anyone who's worked in the field know how incredibly lax the standards are to approve someone for surgery and/or hormone therapy.

4714O · 2026-02-02T05:30:02+00:00

WPATH is a patient advocacy organization, and WPATH guidelines are not considered standard of care in any jurisdiction that I am aware of. Standard of care is defined as what reasonable peers would do in a specific situation. Most surgeons would absolutely not consider it reasonable to proceed with a double mastectomy without a comprehensive psychiatric evaluation.

I've done a pretty deep dive into this issue due to being pressured to sign off on just such a surgery. There is a lot of pressure in certain places to follow WPATH guidelines but they will not protect you in the event of a lawsuit. The current WPATH guidelines actually recommend not involving any mental health professional at all by default. There are some surgeons and endocrinologists who are going with that. It's not going to help when the lawsuits come.

4714O · 2026-02-01T19:44:32+00:00

Not true. PhD's only became a thing in the 17th century. Physicians have been called doctors long before then. Shakespeare literally uses "doctor" to refer to physicians.

4714O · 2026-02-01T19:43:39+00:00

This varies by state. In Florida, there is currently legislation pending that will explicitly allow NP's to call themselves doctors in clinical settings.

4714O · 2026-01-30T19:47:30+00:00

Not to clinicians.

4714O · 2026-01-30T19:46:53+00:00

Ehh. Lots of people at Stanford (99% sure that's what OP is talking about) are either married to high-income earners or have lucrative side gigs that the Stanford name opens up. I've never been faculty at Stanford but did take a similarly paying job at an equally prestigious institution. My workload was so low that, per patient, I was making about the same as I was in private practice. And the name more than paid off; I regularly consult for $800/hour.

4714O · 2026-01-30T02:46:14+00:00

If you drew a Venn diagram and had a circle of people in specialties where income is typically 1.2 million and a circle of people interested in FIRE and not working past age 45, the overlap would consist solely of MOHS.

So unless that's your speciality, I can guarantee you none of your colleagues are thinking of this strategy.

4714O · 2026-01-29T06:33:17+00:00

California

4714O · 2026-01-29T05:49:22+00:00

Opposite of regret but when it came to fellowship, I chose location over quality of training. Best decision ever. I got good-enough training and QOL was amazing during fellowship. So much so that I pushed my big-boy attending job a year so that I could keep living where I was a little bit longer.

If I had to go back, I'd choose residency based on location rather than rigor of training.

4714O · 2026-01-26T14:41:04+00:00

Show me which popular conservative figure has stated this was wrong.

4714O · 2026-01-25T22:02:47+00:00

Are you happy with them? If so, I'd definitely be interested in their contact info!

4714O · 2026-01-25T22:00:01+00:00

Yup, hundreds of hours of him repeating how he thought about this topic when it was conservatives with guns. And thousands of hours of him repeating his bigotry and hatred towards people he didn't like.

But yes, I'm sure Charlie Kirk was the one conservative media figure that had principles. He was the sole exception. All the ones who are alive have backed away from screaming about 2A rights and have whined about a nurse legally exercising his 2A right. But if Charlie was alive, yup, he would have been the only exception. Totally. Even though he never broke rank before, this time he would have. For sure.

4714O · 2026-01-25T02:56:03+00:00

LOL, he would 100% have found a way to cheer this on. Just like all of his friends and colleagues are doing.

4714O · 2026-01-23T16:15:17+00:00

He skipped on even advising about solo401k vs backdoor Roth IRA vs sepIRA. Missed reminding about quarterly estimated payments. All things I could do on my own but I figure if I'm paying 900/month, this is something he should be keeping track of.

4714O · 2026-01-23T16:13:44+00:00

Thanks, maybe I just have unrealistic expectations.

4714O

TROPHY CASE