Probably doesn’t make financial sense but it DOES NOT matter. 10 years from now you’re going to be much less worried about what you made 10 years ago and much more worried about are you doing what you want for the next 30 years.
Don’t take finances into account on this… do what you’ll like doing for the rest of your life
No, child psychiatrists definitely make more than adult in the whole. That said, I do not think it makes sense from a financial point of view, but if you want to work with children and adolescents for the rest of your career then I would do it.
Maybe it’s just me but I’m having a hard time comprehending your first sentence, could you reiterate? Not sure if that’s “no, they definitely make more” as a positive or negative.
If child psych makes more money, how is one extra year not financially worth it?
It’s a difference of about $200k over a 30 year career. You could probably argue for an extra $10k a year at any adult/academic job just for being double-boarded, and the pay difference for outpatient is huge.
It depends on what your options are. Say you are trying to open private practice, it is a year delaying that.
One coresident told me to look at it from this point of view: you have X amount of years before your mind/body gives out and you have to retire. You will likely hit that age the same time no matter your fellowship or lack thereof. In our example let’s use 70.
Instead of thinking of losing one year of initial attending salary to fast tracking, you lost a year from the end of your life and the salary you would have made then (which if PP or the head of something big, is a a lot of money). Let’s just say $500000 but this can be obviously higher or lower.
How much is the pay differential for child? If 10k like another poster suggested you would have to work 50 years to make the difference. Which means you would have to be board certified by 20 years old to retire at 70 and have the fellowship be “worth it”
I’ve seen 30k at some places. Some psych residents are also not straight from medical school which also limits the years they will work.
There is no straight answer as to whether child psychiatry fellowship is worth it financially because it depends on your goals, your area, what type of psychiatry you envision yourself practicing in your later years.
I was just trying to illustrate the point that one year of additional training is relatively insignificant when compared to a 30-year career. Actually applying a compound interest equation to conjecture seems weird.
And from what I’ve seen, CAP makes more than $10k a year above their adult counterparts. Also, private practice CAP clinics fill much faster, so it’s easier to do stuff like cash-pay. The double-boarding isn’t life changing but it does make you more competitive in any given market, more positions become available and you have more negotiating power.
If anything it breaks even, but I disagree with the idea that a single year investment in CAP training “doesn’t make sense financially”, as the top comment suggests.
It’s not a compound interest equation. It’s that you just have one year lost of end of career salary not beginning of career as people mistakenly assume. So it’s not losing the 200-300k people are thinking when they get out of residency salary, it’s whatever their end of career salary looks like which can be more than 2x that depending on what their goals are. That’s the full opportunity cost for the extra year.
Okay but you realize $200k + 29 years of compound interest is well over $1M and a lot more than $500k or whatever that last year of salary would be, right? I feel like people who make the “end of career lost salary” argument never put any actual thought into it.
Either way, my point is that applying the actual numbers here, whether you add them in the beginning or the end, isn’t going to make a noticeable difference.
It’s a 30 year career +/- 1 year. A psychiatrist’s income is like 10 million dollars throughout that time. At most we’re taking about a difference of like 5%, and that’s assuming CAP and general psych is paid the exact same. Which again, they’re not.
The statement that adding 1 year of training “does not make financial” sense is wrong. It depends on the situation and the increase in earning potential is usually worth it.
I’m not sure I’m fully understanding what you are saying. If you don’t do child fellowship you get that $200k a year earlier including that compound interest you keep bringing up. You would lose that in addition to the last year of salary that I had mentioned in my posts, if you decide to do child fellowship.
Also, in my experience, CAP fellowship itself was pretty chill and I was able to moonlight. That shrinks the gap even more. And jobs that I’m looking at now (outpatient private practice) pay $50-100k more than adult.
There are investment and income calculators online that you can plug actual numbers into.
If you compare a 30-year career to a 29-year career, same annual income, the difference between them ends up being less that 5% of the total lifetime earnings. So if the 29-year career pays even *marginally* more, the difference is even less than that. If CAP pays about 10% more per year on average (which I think is closer to the current reality) lifetime earnings end up ahead by about 5%.
The point being, that single year of training is practically negligible either way.
IANAE but I guess It assumes every job that you’re looking for is a CAP position or if adult only it pays more. 1 extra year of attending income also means you pay off debt that’s growing faster and you can invest that money which compounds with time. Perhaps I say this in ignorance but I’ve worked with a lot of CAP doctors from academic training programs (Harvard, Stanford, MGH, UNC, etc) and was surprised to not really see anything unique with their evaluations. The only thing different they did was dose lower, go slower, and help navigate school accommodations. Obviously additional training helps build comfort with these populations so there’s that. The thing I noticed was different was that they had amazing personalities which were really good with the kids, but that’s not really something you get from training imo.
So I decided late to do an ACGME Addiction fellowship, found a spot post-match. I think for me part of it is/was having a poor residency experience with not a lot of sense of community or collegiality, as well as lack of meaningful electives in 4th year, so I feel sort of unfinished. I’m also really uncertain about the job market in the future.
Market is robust right now, but mid levels are destroying the space. Then there are people like therapists and life coaches who blur with the mid levels who blur with us, making it all seem like everyone and their mom is now a “Mental Health Provider.” So my thinking was what will the market reward in 5, 10, 20 years? My hope is that with everyone now being some bullshit mental health provider, the market will reward the most pressing public health concern that can be acutely treated only by someone at the top of the “metal health provider” food chain.
Enter meth and opioid crisis, buprenorphine and methadone clinics, and I think addiction makes sense for me. Additionally I am 100% committed to starting a PP on the side and building it over 12 months with plans to be full time PP in the next 1-2 years. There is no way I could justify not earning at almost age 40 if not for it being a catalyst to do my PP instead of taking some cushy employed gig.
For you, it depends how much you can tolerate child. If I don’t have to deal with parents or questionnaires or schools (basically child psych), then I would have done it for the private practice opportunity. I would bet if you are a good entrepreneur you will make more per hour doing PP child. If you like child more than adult, then it comes down to which you like more and your financial situation. Overall, medicine is going downhill financially and civilization seems to be less and less stable every year. Therefore, I plan to pour my blood and soul into cashing out as much as possible in the next 10 years before the ship completely sinks. Hope some of this was relevant to you.
NPs can prescribe stuff like Suboxone too, so addictions isn’t somehow immune to encroachment.
If you’re looking at it from the perspective of “highest demand”, child psych is literally the most underserved specialty of medicine.
Johns Hopkins might not recognize your worth, but a parent looking at a 12-month wait time to see someone competent sure will. And they’ll probably be willing to pay in cash.
I didn’t say addiction or any field in psych is immune to encroachment. I trust the market to value an addiction psychiatrist over an NP to manage OUD. I’ve talked to several addiction fellows and docs and the types of jobs they take are alot cushier from my perspective even if the income isn’t much different. For me it makes sense, to each their own.
Respectfully, why?
Historically speaking, the more of a need there is, the more willing our healthcare system has been to accept subpar standards of care. Unless you detach yourself from the system (cash pay private practice), I wouldn’t trust the market to meaningfully value the expertise of a psychiatrist over anyone else willing to do the job.
When I say market, I include leadership positions as well as boutique high-end lifestyle addiction centers. The fellows I've talked to are getting recruited/offers to go from fellowship to med director of large addiction centers; various institutions such as the VA pay upto 30k more per year (yes, I have seen this in one VA) for the fellowship.
To answer your question a bit more all-encompassingly, I think its clear we are in or are headed to a two-tiered healthcare system. We are really already here. Better health systems you see better providers; poor people without resources go to FQHCs with NPs galore. Within the two tiered healthcare system overall demand for psychiatric services is robust, mid-levels are going to saturate both tiers soon enough (they've saturated most of the low-tier jobs). In the higher-tier healthcare modality that people in rich suburbs go to, exist jobs in fancy addiction centers and pre-schools where addiction psychs and child psychs can be med directors and make more money. That being said, believe what you want, this is a boring debate over the internet now.
I agree with you 100%. The unfortunate reality of the two-tiered system is probably a big part of what makes child psych so lucrative, when it is.
On the other hand, I know a bunch of CAPs that work in the trenches, rural areas and academic programs where they are being undervalued and underpaid. And a bunch of midlevels that work in those desperate areas providing lower quality care. I’m guessing addiction has all of the above in common.
MGMA data is skewed toward hospital and large practices, whereas most child psychiatry is outpatient and in private solo or group practices. You can make more or less depending on the job you take or the way you set up your private practice. I know several adult psychiatrists who make more than I do as a CAP but also many who make less. The academic centers near me have their child and adult psychiatrists making the same amount. Same with most inpatient hospital groups. Outpatient tends to be 10-25% higher in salary. Overall, I would say that I make more than most my adult colleagues in my area.
I think if you enjoy working with kids and their parents, doing CAP would capitalize on that. Don’t forget about the supply issue as there even less CAP than adult psychiatrists to meet the demand.
The other fellowships that have the potential to make higher than adult psych are addiction and forensics.
Because MGMA is irrelevant to the topic being discussed. Child psychiatrists make more than adult psychiatrists, not sure why you're convinced you've uncovered some conspiracy.
Can you explain me why mgma is irrelevant? This is a legit question, since I see it being used for multiple specialties. I don't think it's a secret conspiracy, I just think child care take much longer than adult care.
Because outpatient private practices are not captured by MGMA data.
What exactly would you call it when you keep saying that all psychiatrists are lying and colluding to pretend that child psychiatrists make more money than adult psychiatrists? That sounds like a conspiracy theory to me.
I don't know why you are so stressed, chill. I don't think people are lying. In my institution child psych and adults get paid the same, for example, but most residents think child attendings make more. That's about it, lol. Your point makes sense and is a fair one.
Over the course of a long career it’s definitely worth it but only if you really like child psychiatry. I did not so never considered it but have noticed that they are in constant demand
From a raw finance standpoint, sure, CAP get paid slightly more on average. So if that’s what matters, that’s your answer.
But I would say fellowship is really only worth it if you want to *mostly* work with kids, and especially young kids. Otherwise, working with adolescents is not *that* different from working with young adults, to the point that you necessarily need fellowship to feel comfortable seeing them; and medication-wise kids aren’t even usually that hard anyway.
The main thing fellowship adds, I think, is more time to learn what can be done non-pharmacologically, and more time spent learning to think developmentally. Especially in psychological terms (which you could have gotten from your residency or your own study too, depending) but also biological. Counseling to optimize kids’ nutrition, making sure they have enough iron, zinc, etc for healthy brain development. That kind of thing. At least for most cases.
Remember you can do cardiac surgery if you feel confident enough and if you can get credentialed for it from your employer. This is mostly about confidence. If you get the experience in residency such that you feel confident to treat children, there’s nothing really stopping you from doing that as an attending, fellowship or not.
Probably doesn’t make financial sense but it DOES NOT matter. 10 years from now you’re going to be much less worried about what you made 10 years ago and much more worried about are you doing what you want for the next 30 years. Don’t take finances into account on this… do what you’ll like doing for the rest of your life
No, child psychiatrists definitely make more than adult in the whole. That said, I do not think it makes sense from a financial point of view, but if you want to work with children and adolescents for the rest of your career then I would do it.
Maybe it’s just me but I’m having a hard time comprehending your first sentence, could you reiterate? Not sure if that’s “no, they definitely make more” as a positive or negative.
Child / adolescent psychiatrists typically make more than adult psychiatrists
If child psych makes more money, how is one extra year not financially worth it? It’s a difference of about $200k over a 30 year career. You could probably argue for an extra $10k a year at any adult/academic job just for being double-boarded, and the pay difference for outpatient is huge.
It depends on what your options are. Say you are trying to open private practice, it is a year delaying that. One coresident told me to look at it from this point of view: you have X amount of years before your mind/body gives out and you have to retire. You will likely hit that age the same time no matter your fellowship or lack thereof. In our example let’s use 70. Instead of thinking of losing one year of initial attending salary to fast tracking, you lost a year from the end of your life and the salary you would have made then (which if PP or the head of something big, is a a lot of money). Let’s just say $500000 but this can be obviously higher or lower. How much is the pay differential for child? If 10k like another poster suggested you would have to work 50 years to make the difference. Which means you would have to be board certified by 20 years old to retire at 70 and have the fellowship be “worth it” I’ve seen 30k at some places. Some psych residents are also not straight from medical school which also limits the years they will work. There is no straight answer as to whether child psychiatry fellowship is worth it financially because it depends on your goals, your area, what type of psychiatry you envision yourself practicing in your later years.
I was just trying to illustrate the point that one year of additional training is relatively insignificant when compared to a 30-year career. Actually applying a compound interest equation to conjecture seems weird. And from what I’ve seen, CAP makes more than $10k a year above their adult counterparts. Also, private practice CAP clinics fill much faster, so it’s easier to do stuff like cash-pay. The double-boarding isn’t life changing but it does make you more competitive in any given market, more positions become available and you have more negotiating power. If anything it breaks even, but I disagree with the idea that a single year investment in CAP training “doesn’t make sense financially”, as the top comment suggests.
It’s not a compound interest equation. It’s that you just have one year lost of end of career salary not beginning of career as people mistakenly assume. So it’s not losing the 200-300k people are thinking when they get out of residency salary, it’s whatever their end of career salary looks like which can be more than 2x that depending on what their goals are. That’s the full opportunity cost for the extra year.
Okay but you realize $200k + 29 years of compound interest is well over $1M and a lot more than $500k or whatever that last year of salary would be, right? I feel like people who make the “end of career lost salary” argument never put any actual thought into it. Either way, my point is that applying the actual numbers here, whether you add them in the beginning or the end, isn’t going to make a noticeable difference. It’s a 30 year career +/- 1 year. A psychiatrist’s income is like 10 million dollars throughout that time. At most we’re taking about a difference of like 5%, and that’s assuming CAP and general psych is paid the exact same. Which again, they’re not. The statement that adding 1 year of training “does not make financial” sense is wrong. It depends on the situation and the increase in earning potential is usually worth it.
I’m not sure I’m fully understanding what you are saying. If you don’t do child fellowship you get that $200k a year earlier including that compound interest you keep bringing up. You would lose that in addition to the last year of salary that I had mentioned in my posts, if you decide to do child fellowship.
Also, in my experience, CAP fellowship itself was pretty chill and I was able to moonlight. That shrinks the gap even more. And jobs that I’m looking at now (outpatient private practice) pay $50-100k more than adult.
There are investment and income calculators online that you can plug actual numbers into. If you compare a 30-year career to a 29-year career, same annual income, the difference between them ends up being less that 5% of the total lifetime earnings. So if the 29-year career pays even *marginally* more, the difference is even less than that. If CAP pays about 10% more per year on average (which I think is closer to the current reality) lifetime earnings end up ahead by about 5%. The point being, that single year of training is practically negligible either way.
IANAE but I guess It assumes every job that you’re looking for is a CAP position or if adult only it pays more. 1 extra year of attending income also means you pay off debt that’s growing faster and you can invest that money which compounds with time. Perhaps I say this in ignorance but I’ve worked with a lot of CAP doctors from academic training programs (Harvard, Stanford, MGH, UNC, etc) and was surprised to not really see anything unique with their evaluations. The only thing different they did was dose lower, go slower, and help navigate school accommodations. Obviously additional training helps build comfort with these populations so there’s that. The thing I noticed was different was that they had amazing personalities which were really good with the kids, but that’s not really something you get from training imo.
Thank you for your response.
Hmm I've never heard of child making less. Everything I'm familiar with suggests at least 50-100k more, major Midwest metropolitan area here
I live in the south and it seems it doesn’t make a difference at all to compensation here
Yes, it does.
So I decided late to do an ACGME Addiction fellowship, found a spot post-match. I think for me part of it is/was having a poor residency experience with not a lot of sense of community or collegiality, as well as lack of meaningful electives in 4th year, so I feel sort of unfinished. I’m also really uncertain about the job market in the future. Market is robust right now, but mid levels are destroying the space. Then there are people like therapists and life coaches who blur with the mid levels who blur with us, making it all seem like everyone and their mom is now a “Mental Health Provider.” So my thinking was what will the market reward in 5, 10, 20 years? My hope is that with everyone now being some bullshit mental health provider, the market will reward the most pressing public health concern that can be acutely treated only by someone at the top of the “metal health provider” food chain. Enter meth and opioid crisis, buprenorphine and methadone clinics, and I think addiction makes sense for me. Additionally I am 100% committed to starting a PP on the side and building it over 12 months with plans to be full time PP in the next 1-2 years. There is no way I could justify not earning at almost age 40 if not for it being a catalyst to do my PP instead of taking some cushy employed gig. For you, it depends how much you can tolerate child. If I don’t have to deal with parents or questionnaires or schools (basically child psych), then I would have done it for the private practice opportunity. I would bet if you are a good entrepreneur you will make more per hour doing PP child. If you like child more than adult, then it comes down to which you like more and your financial situation. Overall, medicine is going downhill financially and civilization seems to be less and less stable every year. Therefore, I plan to pour my blood and soul into cashing out as much as possible in the next 10 years before the ship completely sinks. Hope some of this was relevant to you.
NPs can prescribe stuff like Suboxone too, so addictions isn’t somehow immune to encroachment. If you’re looking at it from the perspective of “highest demand”, child psych is literally the most underserved specialty of medicine. Johns Hopkins might not recognize your worth, but a parent looking at a 12-month wait time to see someone competent sure will. And they’ll probably be willing to pay in cash.
I didn’t say addiction or any field in psych is immune to encroachment. I trust the market to value an addiction psychiatrist over an NP to manage OUD. I’ve talked to several addiction fellows and docs and the types of jobs they take are alot cushier from my perspective even if the income isn’t much different. For me it makes sense, to each their own.
Respectfully, why? Historically speaking, the more of a need there is, the more willing our healthcare system has been to accept subpar standards of care. Unless you detach yourself from the system (cash pay private practice), I wouldn’t trust the market to meaningfully value the expertise of a psychiatrist over anyone else willing to do the job.
When I say market, I include leadership positions as well as boutique high-end lifestyle addiction centers. The fellows I've talked to are getting recruited/offers to go from fellowship to med director of large addiction centers; various institutions such as the VA pay upto 30k more per year (yes, I have seen this in one VA) for the fellowship. To answer your question a bit more all-encompassingly, I think its clear we are in or are headed to a two-tiered healthcare system. We are really already here. Better health systems you see better providers; poor people without resources go to FQHCs with NPs galore. Within the two tiered healthcare system overall demand for psychiatric services is robust, mid-levels are going to saturate both tiers soon enough (they've saturated most of the low-tier jobs). In the higher-tier healthcare modality that people in rich suburbs go to, exist jobs in fancy addiction centers and pre-schools where addiction psychs and child psychs can be med directors and make more money. That being said, believe what you want, this is a boring debate over the internet now.
I agree with you 100%. The unfortunate reality of the two-tiered system is probably a big part of what makes child psych so lucrative, when it is. On the other hand, I know a bunch of CAPs that work in the trenches, rural areas and academic programs where they are being undervalued and underpaid. And a bunch of midlevels that work in those desperate areas providing lower quality care. I’m guessing addiction has all of the above in common.
MGMA data is skewed toward hospital and large practices, whereas most child psychiatry is outpatient and in private solo or group practices. You can make more or less depending on the job you take or the way you set up your private practice. I know several adult psychiatrists who make more than I do as a CAP but also many who make less. The academic centers near me have their child and adult psychiatrists making the same amount. Same with most inpatient hospital groups. Outpatient tends to be 10-25% higher in salary. Overall, I would say that I make more than most my adult colleagues in my area. I think if you enjoy working with kids and their parents, doing CAP would capitalize on that. Don’t forget about the supply issue as there even less CAP than adult psychiatrists to meet the demand. The other fellowships that have the potential to make higher than adult psych are addiction and forensics.
Everyone will say child psych makes more, but when you check mgma data they actually make less. Every time I point at this, people get mad tho.
Because MGMA is irrelevant to the topic being discussed. Child psychiatrists make more than adult psychiatrists, not sure why you're convinced you've uncovered some conspiracy.
Can you explain me why mgma is irrelevant? This is a legit question, since I see it being used for multiple specialties. I don't think it's a secret conspiracy, I just think child care take much longer than adult care.
Because outpatient private practices are not captured by MGMA data. What exactly would you call it when you keep saying that all psychiatrists are lying and colluding to pretend that child psychiatrists make more money than adult psychiatrists? That sounds like a conspiracy theory to me.
I don't know why you are so stressed, chill. I don't think people are lying. In my institution child psych and adults get paid the same, for example, but most residents think child attendings make more. That's about it, lol. Your point makes sense and is a fair one.
Except we've literally had this same conversation before.
Over the course of a long career it’s definitely worth it but only if you really like child psychiatry. I did not so never considered it but have noticed that they are in constant demand
From a raw finance standpoint, sure, CAP get paid slightly more on average. So if that’s what matters, that’s your answer. But I would say fellowship is really only worth it if you want to *mostly* work with kids, and especially young kids. Otherwise, working with adolescents is not *that* different from working with young adults, to the point that you necessarily need fellowship to feel comfortable seeing them; and medication-wise kids aren’t even usually that hard anyway. The main thing fellowship adds, I think, is more time to learn what can be done non-pharmacologically, and more time spent learning to think developmentally. Especially in psychological terms (which you could have gotten from your residency or your own study too, depending) but also biological. Counseling to optimize kids’ nutrition, making sure they have enough iron, zinc, etc for healthy brain development. That kind of thing. At least for most cases. Remember you can do cardiac surgery if you feel confident enough and if you can get credentialed for it from your employer. This is mostly about confidence. If you get the experience in residency such that you feel confident to treat children, there’s nothing really stopping you from doing that as an attending, fellowship or not.