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The employment forecast for child and adolescent psychiatrists looks promising in both the private and public sectors. So said panelists at the annual meeting of the American Academy of Child and Adolescent Psychiatry last month in Toronto.
There are many openings for staff positions with attractive salaries in private for-profit clinics and hospitals, according to John Dunne, M.D., an associate clinical professor of psychiatry at the University of Washington in Seattle. Starting salaries for inpatient staff positions range from $150,000 to $200,000 annually with benefits.
"Because the salaries are higher than those in outpatient settings, the competition among psychiatrists for these positions is greater," said Dunne.
The financial pressures on staff to generate income also may be greater. "I would recommend hiring an attorney to review the contract so you clearly understand the implications before signing."
Although most positions are clinical, there are opportunities to specialize and develop new programs in institutions with several psychiatrists on staff, added Dunne. "It can be very exciting to be involved with developing programs like partial hospitalization and being on the cutting edge of things."
Outpatient staff positions for child and adolescent psychiatrists are expanding rapidly in for-profit HMO’s and group health plans, observed Dunne. Starting salaries run generally $100,000 or less.
"I can assure you that psychiatrists working in outpatient for-profit settings are under tremendous pressure to see patients every 10 to 15 minutes all day long," said Dunne. Moreover, "there is pressure on the clinical staff to design highly efficient systems of clinical care with the least amount of money."
Increasingly, the line between private and public sector populations is blurred as private outpatient clinics contract with managed care companies.
About 85 percent of child and adolescent psychiatrists are in some form of private practice, noted Dunne, who maintains a full-time private practice in Renton, Wash. "Private practice offers the potential to interface with schools and other providers, and to develop a practice that suits individual interests and proclivities."
Nonetheless, setting up a practice can be expensive, especially for more complex systems involving managed care contracts. Dunne noted that some child and adolescent psychiatrists in less-populated areas have chosen not to deal with managed care referrals and have developed a successful practice treating the "upscale middle class."
However, 60 percent of patients are insured through managed care so it is important to practice efficiently to attract large volumes of patients, said Dunne. He predicted that the number of solo practitioners will decrease because of managed care but not disappear.
"Fewer people will have a full-time private practice that supports them comfortably," Dunne said. "Many psychiatrists will have a part-time private practice while working primarily in a health center or academic setting."
Perry Bach, M.D., chief child and adolescent psychiatrist at the Colorado Mental Health Institute in Pueblo, said that public sector opportunities for child and adolescent psychiatrists should expand, especially in remote areas. There are full-time salaried and part-time hourly clinical and administrative positions.
Psychiatrists working part time for managed care organizations are paid hourly for medication management and not consultations, said Bach. "In contrast, salaried positions allow psychiatrists to have more control over their time and perform a range of services, including consultations with teachers, social workers, and juvenile judges."
Psychiatrists can be employed as civil servants in a government agency or work in a quasi-governmental agency or private nonprofit agency. "Depending on the agency, there may be opportunities to work on special projects related to the psychiatrist’s interests and the agency’s mission," said Bach.
Psychiatrists are increasingly working in proprietary agencies or managed care agencies under contract with the state government to manage the Medicaid population, said Bach. "Many state agencies and departments are getting out of direct service delivery and becoming strictly administrative and contract-administration bureaucracies."
Child and adolescent psychiatrists may be hired by government agencies to write and monitor contracts or by managed care organizations to do program planning and evaluation.
"Psychiatrists considering working in the public sector should ask about the future direction of community and state agencies, structure of the agency, and how they will fit in," recommended Bach.
Public sector salaries are competitive with academic and nonprofit agency salaries, said Bach. "In Colorado, starting annual salaries for child and adolescent psychiatrists range between $90,000 and $120,000. The high end is more common in remote areas of the state where there are fewer programs."