Early career psychiatrist looking at Madison, WI area

[newpsychgrad]

Happy Saturday everyone,

I've been reading WCI for a while and have greatly benefited - glad I found this site when I did! I'm set to graduate from adult psychiatry residency next year, and am looking at the Madison, WI metro area for employment as one option. Other areas I'm comparing are Twin Cities, Milwaukee, Chicago, and smaller towns in southern Wisconsin. I was wondering if anyone here practices or has practiced in these areas and could give me a sense for saturation versus need for psychiatrists, any health systems to look into further (or avoid), and any sense you might have on what kind of MGMA percentiles people are seeing in these areas (if you can share, roughly). One reason I'm asking is I've noticed many positions in Madison are well below the median numbers I've seen for psychiatry, and I'm not sure if that's a fluke or if it reflects a saturated market. Also interested if anyone has worked for any of the health systems or HMOs around southern Wisconsin.

Thanks in advance! Have a great weekend!

[wideopenspaces]

I'm a psychiatrist ( 3 years out of residency) but no experience with those areas. I have a friend from residency who is working in Madison. If you want their contact info, send me a message. I'm sure he'd love to chat.

[Antares]

I don’t know anything about these areas. But if they are anything like the NYC metro area, you will make substantially more in private practice than employed, with much more control of your work life. I would recommend being the higher cost alternative to lower quality institutional care offerings.

[Lithium]

Not familiar with the area, but any medium-sized college town, with few other large appealing cities nearby, that also puts out lots of home-grown grads every year, seems optimal for market saturation.  I also did residency in a place like that and took at least a 50% raise by moving.

Now if you go into cash private practice, it doesn't matter as much, as long as you can find patients with money.

[nachos31]

I'm in the Twin Cities doing primary care for one of the largest health groups and can say we are desperate for more psychiatrists and mental health providers on the whole to refer to (in any health system). Not sure what the going rate is here for psychiatry but they are always booked out months so demand must work in their favor. Give us a closer look. PM if you have questions, etc.

[adventure]

newpsychgrad wrote:

if that’s a fluke or if it reflects a saturated market.

Click to expand...

It might also be that Madison is the "cool" place to live in Wisconsin.

[FCP]

There is no such thing as a location saturated with psychiatrists.  You'll have more work than you can handle no matter where you go.

[newpsychgrad]

Thanks for all the input - both the replies here and the messages I've received, this is very helpful. When you all see new residency grads taking employed positions right after completing training (psychiatry or other fields), do you recommend that new grads aim for median compensation in your field or do you see it as more realistic to start at a lower percentile (30-40th percentile? lower?). This is assuming approximately median FTE workload without tons of extra call or side work. Just trying to get an idea, as my mentors/faculty have commented that some of the positions I'm seeing have starting salaries for new grads that "run low", in the low 200s, when median compensation for psych looks like 240k+ on some surveys. Another confounding factor is inpatient versus outpatient, when I'm looking at all outpatient roles.

Thanks again for taking the time to educate! It's much appreciated and will be paid forward when the time comes.

[Antares]

Is the first job aimed at growing into it and advancing into a better employed position? If not, the more importent thing is what opportunity it will give you to transition into a private practice role. For example, I worked in an academic setting with primarily clinical duties for three years after finishing training. This allowed me to build up a network, go part time and build up a part time practice, and then a year later quit the job and go into full time private practice. If the intention is to stay at a job, then I’d want to see the long term plan to gauge the impact of that first decision.

[newpsychgrad]

Thanks for the input Antares. One of the practice groups has a 3 year schedule where the fixed salary rises each year, not dramatically but >4% per year. Other groups move toward production by year 2-3. The academic positions I've looked at are much more opaque from a compensation perspective, not sure how to figure out more details, but it looks like academics in general will have more call and less pay/time with more unpaid obligations. I'm lukewarm on academics at this point, maybe I'll be more excited down the road as I forget the details of residency...

[Antares]

I get that. But it still seems to me that the current decisions would be easier to make if you had a clear long term goal. If you don’t, then so be it. Make the decision based on what you know.

[newpsychgrad]

Good point. I'm considering trying my hand at a part-time private practice on the side, either telepsych and/or in person, though have no experience or training in this. It's both exciting and overwhelming as I read about all the pieces that need to be in place to see patients outside of an established clinic/health system. One of the positions would leave my weekends and most evenings free, which would allow me to set something up on the side. I would certainly try out a few hours per week of private practice on the side before launching into a full time practice on my own. Thankfully there's no non-compete at most of the places I'm looking into. That's mostly been a non-issue in my geographic areas of interest.

[Lithium]

newpsychgrad wrote:

Thanks for all the input – both the replies here and the messages I’ve received, this is very helpful. When you all see new residency grads taking employed positions right after completing training (psychiatry or other fields), do you recommend that new grads aim for median compensation in your field or do you see it as more realistic to start at a lower percentile (30-40th percentile? lower?). This is assuming approximately median FTE workload without tons of extra call or side work. Just trying to get an idea, as my mentors/faculty have commented that some of the positions I’m seeing have starting salaries for new grads that “run low”, in the low 200s, when median compensation for psych looks like 240k+ on some surveys. Another confounding factor is inpatient versus outpatient, when I’m looking at all outpatient roles.

Thanks again for taking the time to educate! It’s much appreciated and will be paid forward when the time comes.

Click to expand...

Aim as high as possible.  Do not underestimate your value.  You do not get what you deserve, you get what you ask for.

The psychiatry forum on student doctor is a decent place to learn more about this.  Basically there is no fair justification to lowball someone for being a new grad.  If an employer tells you that your pay goes up based on years of experience, ask them "Do payers compensate you based on my years of experience?"

Seniority has an important role in many fields but is overrated in clinical medicine.

[q-school]

Hmmm. The compensation may not increase with seniority but the efficiency might. Billing may become better with experience. Costs can be lowered with experience. Maybe it depends on specialty. Nonclinical work likely will increase with experience.

[newpsychgrad]

Thanks. It seems pretty common though for groups and hospital systems to offer a graduated/escalating salary plan the first few years out of residency (ex: 225k/235k/then production, or 205/215/225k base salary then renegotiate), maybe because it takes time for the schedule to fill? Or to make sure you're a good fit for the group and are meeting expectations? Not sure. Certainly a private practice would experience this ramping effect in a much more dramatic way, depending on how fast you fill. You'd see year-by-year leaps of tens of thousands of income as your practice (hopefully) grows if you were taking the financial hit of an unfilled schedule slot yourself in solo private practice, versus an employer eating the cost. Or consider if you were eating the costs as you tried and failed to collect from certain insurers or certain patients as you get more business savvy. Just some thoughts, I have no experience with any of the business side of medicine.

The other question I have is: who is making 10th, 20th, 30th etc percentile income, if not new residency grads? Not everyone gets to make median and above income, by definition.