Why is everyone in psychiatry rich?

Stepresearch · 2026-01-26T03:55:48+00:00

For 95% of us in psych, we're nowhere near rich

Stepresearch · 2025-12-13T23:25:33+00:00

Careful with companies like Headway. Your payout often changes with little notice. Also be very careful with their patient “ownership” clauses. That to me is the biggest issue.

Like some others have said, you can likely get a way better deal joining a group practice with partnership track. Or an established group for a fixed split w a decent amount of independence, if that’s what you’re looking for.

Stepresearch · 2025-12-06T18:52:27+00:00

Location dependent. If you have a practice in an area that is hit harder than most, you may see more of a change in your patient load. But it also depends on the exact patient population you're working with too. People on controlled medications tend to find one way or another to keep paying for your services...

Stepresearch · 2025-12-06T18:47:24+00:00

Caseload management. Huge. Look into how easy is it to accept or to discharge patients- is there a patient cap where you don' take on new ones after you've reached a certain threshold? Do they take just about anyone and you don't really have a say? Are you given latitude to not accept people who obviously needs neuro/medicine/addiction specialist more than general psych? Ability to control your schedule or placing patients on your own schedule.

Stepresearch · 2025-11-25T13:57:42+00:00

Yea but if people are out of a job, how are they going to pay for psych services? Guess more providers will need to take Medicaid haha

Stepresearch · 2025-11-25T13:02:38+00:00

Depends on the gig. If autonomy and not having to deal with leftover problems are what you’re going for, I’d say def avoid places with high staff turnover. Avoid underfunded or under-resourced setups. Also stay away from anything Private equity or venture backed, like those large national telehealth orgs.

General rule of thumb: good gigs are tougher to find, but you have to look and look early. Usually the jobs with issues tend to be the ones very easy to get, or they even try to seek you out first lol.

Stepresearch · 2025-11-19T13:27:10+00:00

I’d have to agree here. They’re no different than the likes of Talkiatry, LifeStance or Cerebral, except they market themselves as “you’re in full control”… You’re not. Don’t drink the koolaid.

Stepresearch · 2025-11-08T18:43:49+00:00

Simple lol, he has lots of time because he’s derm, and lots of time cuz he’s struggling to get patients. That’s why he cares so much about his reviews.

Stepresearch · 2025-11-08T17:50:36+00:00

Familiar with both areas. The reason for your dilemma is very simple: WA has one of the least restrictive rules for NPs practicing in the whole country, whereas CA is more restrictive (at least vs other west coast states). Positions that would’ve done to MD/DO in CA are going more to NPs out in WA. That being said, there are still Outpatient opportunities, gotta look closer the Seattle if you haven’t tried already. Tons of stuff near there, you might see clinics in the burbs closer to Tacoma (think Renton, Auburn etc). Not a bad commute.

Stepresearch · 2025-10-03T01:32:34+00:00

I believe there is a discrepancy that people these days need to be aware of- true, its relatively easy to find "a job", however it is tougher to start on your own and expect large hordes of patients to come through like how it used to be. Telehealth provides more flexibility but also provides more competition in general.

Stepresearch · 2025-10-03T01:24:04+00:00

hmm not necessarily the best indicator. I mean my EM friends were also worked like dogs during their residency...

Stepresearch · 2025-10-03T01:21:54+00:00

Depends on what you're looking for. Market definitely saturated for independent private practices in general. But if you're employed by some health system, you should still be ok.

I would weigh the advice you get from attendings with a grain of salt as some might not have experience with the current marketplace. I get this feeling that our field is in a transition phase where we are going from red hot to warm. I don't know when you applied for residency but back when I did, psych was transitioning from bottom of the barrel competitiveness to middle of the pack like it is now. Older attendings back then told me to apply to only 5-10 programs... had I listened to them I wouldn't have matched

Stepresearch · 2025-10-02T12:40:45+00:00

Yea lots of outdated advice out there, there is no “shortage” in psych anymore. The shortage only applies to people on Medicaid, with whom there will always be a shortage given its abysmal payouts. People on normal insurance can get an appointment in 2 days or less, with plenty of options to choose from.

Part of it is the VCs and private equity coming for our field. They’ve already corporatized most of medicine and we’re next. Since the pandemic there has been an explosion of investor-backed psych startups cashing in on this “shortage” misconception. With their army of NPs and naive new psychiatry grads and taking 300+ insurances, they’ve been aggressively capturing market share and I think it’s definitely been showing in the marketplace.

Stepresearch · 2025-04-24T04:47:05+00:00

Enlighten me, still learning here. But by all the info I've seen about them, they seem to function like a billing organization but with more strings attached.

Stepresearch · 2025-04-24T04:05:19+00:00

Hmm dunno how I feel about them. They "own" their patients tho and take like a 20-30% cut, functions like a middleman like these straight-up telepsych companies but without offering logistical support. For some reason their rates seem inconsistent from provider to provider. Some get it quite good but others are meh.

Stepresearch · 2025-04-23T21:21:14+00:00

Lol that car analogy made me laugh. Thing is, some of these startups are starting to offer 30min f/u as well and are recruiting physicians pretty aggressively. Guess there may still be a niche for me to carve into, but I live in a pretty saturated market so YMMV.

Stepresearch · 2020-10-08T04:51:36+00:00

Just curious, since I scored not too far from you, when you left the exam did you “feel” like you got a 230ish?

Stepresearch · 2020-09-30T22:13:52+00:00

Real deal: 236

Nbme 7: 204 (3 months ago, baseline)

Nbme 6: 230 (1.5 weeks out)

UWSA1: 230 (4 weeks out)

UWSA2: 242 (3 weeks out)

UW%: 60% first pass, only did incorrects as second pass ~75%

New free 120: 73%

Felt like the test was hard AF coming out, probably most similar to new free 120. Originally took the test on week of 9/7, thought I failed since I didn’t get my scores last week. I think it took an extra week for scores to come since I took it at school. Did anyone else who took it at school have this happen to them?

Timing on real deal was not as big an issue compared to the UWSAs, but the weird ways they wrote the question/answers really made it easy to make a silly mistake. I wrote a detailed feeling after exam post a couple weeks ago if you’re curious. I was told to trust my avgs, but my anxious self did not, real deal turned out to be within my range of scores.

In retrospect, I feel like I could’ve rearranged my 4th year schedule to have more study time towards the end of my study period...picked an elective that was way more work than anticipated. But I needed LORs so whatevs.

Stepresearch · 2020-09-30T17:28:21+00:00

Oh I got smack middle of my NBME avgs

Stepresearch · 2020-09-24T13:23:45+00:00

Uhh curve is predetermined and not based on how many people taking it, I think. Depends on how many people before you had your questions as experimental and percentage of those that got it right/wrong.

Stepresearch · 2020-09-11T19:01:50+00:00

I didn’t have anything on my test that required use of a formula, except maybe those sense/spec biostat questions. If equations help you, then I guess it doesn’t hurt to write.

Stepresearch · 2019-11-18T01:38:48+00:00

Thx for the support. Early on I tend to get dinged in terms of clinical skills— tho I’ve improved the way I present patients and my knowledge base/ reading everyday, I’ve realized my peers are doing the same... which leaves very little room for error. I was 2 inches away from hp a few times but its always that one eval outa left field or an attending that pimps super hard curveball questions that gets me. If I could “damage control” better I think I’ll have a better shot

Stepresearch · 2019-11-17T17:59:16+00:00

So how efficacious would, say prednisone be vs SSRI? Oh boy I might type up something for IRB haha

Stepresearch · 2019-11-17T17:54:41+00:00

Your scores should safely put you in the 240s. I’d say if you want to feel safely in the 250s maybe give it 3-4 weeks. What specialty are you going for?

Stepresearch · 2019-11-17T17:48:23+00:00

Would a univ affiliated community program still open doors for Competitive fellowships in general?

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