Pediatric-Psychiatry Residency: Physician Salary Insights & Guide

Understanding Physician Salary by Specialty in Pediatrics-Psychiatry

Pediatrics-psychiatry—often encountered through peds psych residency tracks and especially the Triple Board pathway—is a niche, growing area that bridges child health and mental health. As residency applicants explore their options, one of the most common questions is how physician salary by specialty plays out for these hybrid careers.

This guide breaks down how compensation works for pediatrics-psychiatry physicians, how it compares with other fields, and how your training pathway (e.g., triple board vs traditional routes) can influence your long-term earnings and flexibility.

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1. The Landscape of Physician Salary by Specialty

When people ask about doctor salary by specialty, they usually want to know three things:

1. Where a field sits in the national salary “hierarchy”
2. What tradeoffs exist between pay, lifestyle, and length of training
3. How subspecialization or niche skills affect long-term earnings

Across the board:

• Primary care (family medicine, general pediatrics, general internal medicine) tends to be on the lower end of the physician salary spectrum.
• Procedure-heavy and high-intensity specialties (orthopedic surgery, plastic surgery, cardiology, dermatology, gastroenterology, radiology, anesthesiology) tend to rank among the highest paid specialties.
• Psychiatry and child & adolescent psychiatry have historically been middle-of-the-pack, but compensation has been rising due to workforce shortages and increased demand.

Pediatrics-psychiatry physicians are unusual in that they sit at an intersection:

• They are often board-eligible (or certified) in:
  • General pediatrics
  • General psychiatry
  • Child & adolescent psychiatry
• They may work in:
  • Academic medical centers
  • Children’s hospitals
  • Community mental health
  • Integrated health systems
  • Private practice or group practices
  • Collaborative care or consult-liaison roles

This combination leads to a hybrid salary profile that doesn’t fit neatly into most national surveys, which typically report pediatrics and psychiatry separately.

Where Pediatrics-Psychiatry Fits Among Other Specialties

Typical salary tiers (approximate and subject to wide variation by region and practice):

• Highest paid specialties (often $550,000–$800,000+):
  • Orthopedic surgery, plastic surgery, cardiovascular surgery, neurosurgery, interventional cardiology, gastroenterology, radiology, anesthesiology
• Upper-middle range (often $400,000–$600,000):
  • Cardiology (non-interventional), oncology, emergency medicine, urology, dermatology, some surgical subspecialties
• Middle range (often $280,000–$420,000):
  • Adult psychiatry, hospitalist internal medicine, some subspecialty pediatrics, OB/GYN, physiatry (PM&R), neurology
• Lower range (often $220,000–$320,000):
  • General pediatrics, family medicine, general internal medicine, adolescent medicine, academic-heavy pediatric roles

Pediatrics-psychiatry physicians often land in the middle range, with potential to move higher depending on how their practice mix leans (e.g., more psychiatry-heavy vs pediatrics-heavy, clinical volume, and supplemental activities such as medical directorships).

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2. Training Pathways: Triple Board vs Traditional Routes

What is a Peds Psych or Triple Board Residency?

You’ll encounter pediatrics-psychiatry most clearly through the Triple Board residency:

• Triple Board Residency = Combined training in:
  • Pediatrics
  • General psychiatry
  • Child & adolescent psychiatry
• Duration: Typically 5 years
• At completion, graduates are board-eligible in three specialties.

There are also other combined or related pathways, such as:

• Pediatrics–Psychiatry–Child & Adolescent Psychiatry (PP-CAP) tracks in some institutions (similar spirit to triple board, slightly varied structure)
• Sequential training (e.g., pediatrics residency → psychiatry → child & adolescent psychiatry fellowship)
• General psychiatry residency followed by child & adolescent psychiatry fellowship, with a strong focus on pediatric populations

How Training Pathway Influences Income Trajectory

Your total lifetime income is influenced by:

1. Years spent as a resident/fellow vs attending
2. Resulting specialty mix and practice options
3. Speed to higher-earning roles (e.g., psychiatry-focused positions)

For example:

• A traditional general pediatrics resident:

  • ~3 years of residency
  • Then attending pay at general pediatrics level

• A general psychiatry + child & adolescent psychiatry route:

  • Typically 4 years general psychiatry + 2 years child fellowship (often reduced to 5 total with integrated tracks)
  • Attending salary: usually higher than general pediatrics, especially as a child psychiatrist

• A Triple Board resident:

  • 5 years total, one integrated program
  • Board-eligible in three specialties
  • Flexible career design across pediatrics, psychiatry, and child & adolescent psychiatry

From an income standpoint:

• Triple Board training often delays attending-level earnings compared with a straight 3-year pediatrics residency.
• However, the eventual earning potential can be:
  • Similar to or higher than general pediatrics if your practice uses your psychiatry skillset.
  • Comparable to child & adolescent psychiatry roles if you lean heavily into psychiatric care.

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3. Salary Ranges and Practice Patterns in Pediatrics-Psychiatry

Because national reports often don’t carve out pediatrics-psychiatry as a separate line item, it helps to think in practice “profiles” rather than one fixed number.

3.1 General Pediatrics-Focused Practice (With Psych Expertise)

Some triple board or PP-CAP graduates choose to work primarily as:

• General pediatricians in:
  • Academic children’s hospitals
  • Large pediatric groups
  • Community health centers
• They utilize their psychiatric training to:
  • Manage more complex behavioral cases
  • Collaborate with mental health teams
  • Reduce referrals for mild–moderate conditions

Salary profile (approximate, pre-tax, full-time):

• Often similar to general pediatrics:
  • Frequently in the $220,000–$280,000 range in many regions
  • Academic centers can be lower, especially early-career
  • Rural or high-need areas may offer recruitment incentives

Upside: Enhanced job security, leadership roles in behavioral-pediatrics programs, and strong demand from systems trying to integrate mental health into primary care pediatrics.

3.2 Psychiatry-Heavy Practice (Child & Adolescent Focus)

Other graduates practice mostly as:

• Child & adolescent psychiatrists in:
  • Outpatient clinics
  • Partial hospitalization programs (PHPs)
  • Inpatient child psychiatry units
  • Community mental health centers
  • Telepsychiatry

They may do little or no primary pediatrics, instead functioning similarly to any other child & adolescent psychiatrist—but with deeper comfort around medical comorbidities.

Salary profile:

• Often aligns with or slightly exceeds adult psychiatry averages because of high demand:
  • Roughly $280,000–$400,000+, sometimes higher in:
    • High-cost metropolitan areas with shortages
    • Rural or underserved settings with aggressive recruitment
    • Private practice or high-RVU environments

Upside: Tends to be significantly higher than general pediatrics, with many options for flexible schedules, telehealth, and consulting work.

3.3 Balanced Pediatrics-Psychiatry Hybrid Practice

Some physicians genuinely split their time:

• E.g., 0.4 FTE in a general pediatrics clinic + 0.6 FTE in a child psychiatry clinic, or combined clinics for medically complex children with co-occurring psychiatric conditions.
• Institutional roles may include:
  • Medically complex child psychiatry consults
  • Eating disorders programs
  • Autism and developmental-behavioral clinics
  • Pediatric psych consult-liaison on inpatient peds floors

Salary profile:

• Often falls between general pediatrics and child psychiatry benchmarks, depending on:
  • How your employer “slots” your role (peds vs psych salary band)
  • Billing practices (CPT codes for psychiatric services often reimburse better than pediatrics-only visits)
  • Whether you receive medical directorship or program-building stipends

In many cases, a balanced hybrid may land around:

• $260,000–$360,000
  with upside if you negotiate your pay scale based on the psychiatry component of your work.

3.4 Academic vs Community Settings

Academic pediatrics-psychiatry roles:

• Often emphasize:
  • Teaching residents and medical students
  • Research
  • Program development in integrated child mental health
• Tradeoffs:
  • Typically lower base salary than comparable community roles
  • Benefits can include:
    • Loan repayment programs
    • Protected time
    • Academic titles and leadership pathways

Community / private roles:

• Often emphasize:
  • High clinical volume
  • Shorter appointment times (though child psych often still needs longer visits)
• Tradeoffs:
  • Higher base salaries and bonuses
  • Less protected non-clinical time
  • More business/practice management responsibilities in private practice

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4. Factors That Shape Earnings in Pediatrics-Psychiatry

Understanding physician salary by specialty is only part of the story. Within pediatrics-psychiatry, your personal earnings will depend heavily on several modifiable choices.

4.1 Geographic Region and Cost of Living

• Urban centers and coastal cities may offer higher nominal salaries but face:
  • Much higher housing and living costs
• Rural or underserved areas may offer:
  • Loan repayment
  • Sign-on bonuses
  • Stipends for leadership roles
  • Higher overall compensation due to scarcity

Given the nationwide shortage of both pediatricians and child & adolescent psychiatrists, triple board physicians can wield strong negotiating power in many regions.

4.2 Practice Type and Ownership

• Employed positions (hospital systems, academic centers, large groups):
  • Predictable salary + benefits
  • Less administrative burden
  • Limited upside beyond bonuses and defined salary bands
• Private practice or small group ownership:
  • Higher earning ceiling if the practice is well-run
  • More risk and responsibility (billing, overhead, hiring)
  • Greater control over scheduling and case mix

A triple board physician in a child psychiatry–heavy private practice, offering both medication management and therapy or complex consults, can often out-earn many generalist colleagues, though not necessarily competing with the top tier of the highest paid specialties such as orthopedic surgery or cardiology.

4.3 Clinical Volume and Productivity Models

Compensation may be:

• Salary-only
• Salary + productivity bonus (RVU-based or collections-based)
• Collections-based (more typical in private practice)

Child psychiatry and integrated peds-psych services often reimburse well relative to time spent, particularly when:

• Visits are coded accurately and at appropriate levels
• Collaborative care models allow billing for care coordination and indirect services (in some systems)

Your ability to:

• Maintain a sustainable panel of complex patients
• Use a mix of psychotherapy, medication management, and integrated consults
• Stay efficient with documentation and follow-up

…can all influence your take-home pay.

4.4 Subspecialization and Niche Expertise

Within pediatrics-psychiatry, niche areas may carry:

• Higher compensation
• Stronger negotiating leverage

Examples:

• Autism spectrum disorder clinics (especially with comorbid psychiatric and medical conditions)
• Eating disorders programs (often high acuity and high demand)
• Consult-liaison roles for medically complex children (oncology, transplant, chronic illness)
• Pediatric psychopharmacology expertise for rare or complex syndromes

Institutions often struggle to find physicians who can straddle both pediatrics and psychiatry effectively. Triple board graduates are uniquely positioned for these roles—and can sometimes negotiate stipends or higher pay bands as a result.

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5. Comparing Pediatrics-Psychiatry to Other Specialties

To put peds psych and triple board careers in context, it helps to compare them directly with other specialties commonly considered by applicants.

5.1 Compared with General Pediatrics

• Training length:
  • General pediatrics: 3 years
  • Triple board: 5 years
• Salary:
  • General pediatrics: often $220,000–$280,000
  • Triple board, peds-heavy practice: similar range
  • Triple board, psych-heavy or hybrid practice: often $260,000–$380,000+
• Pros for triple board vs pure pediatrics:
  • Broader career options
  • Higher potential earning ceiling if you lean into psychiatry
  • Ability to treat a wider range of conditions and fill critical system gaps

5.2 Compared with Adult Psychiatry

• Training length:
  • Adult psych: typically 4 years residency
  • Triple board: 5 years
• Salary:
  • Adult psychiatry: often $280,000–$350,000+
  • Child & adolescent psychiatry (with or without triple board): often $300,000–$400,000+
• Triple board advantage:
  • Can still earn similar to child psychiatry while retaining ability to practice pediatrics
  • More versatile in roles that require understanding of medical pediatric complexity

5.3 Compared with the Highest Paid Specialties

When evaluating physician salary potential, many applicants benchmark against the highest paid specialties such as:

• Orthopedic surgery
• Cardiovascular surgery
• Interventional cardiology
• Gastroenterology
• Dermatology
• Radiology
• Anesthesiology

Pediatrics-psychiatry—no matter how you structure it—will not usually approach these top-tier earnings, which can exceed $550,000–$800,000 or more.

However:

• Training time and lifestyle can be more favorable:
  • Less frequent overnight in-house call once in practice
  • More predictable clinic hours in many outpatient roles
  • Lower malpractice risk compared to surgical fields
• For applicants who value:
  • Working with children and families
  • Managing both medical and psychiatric complexity
  • Longitudinal, relationship-based care
    …peds psych offers a strong mission-fit with moderate to solid earnings.

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6. Practical Advice for Residency Applicants Interested in Peds Psych

6.1 Clarify Your Long-Term Practice Vision

Before focusing on salary alone, ask yourself:

• Do I see myself primarily as:
  • A pediatrician who is exceptionally strong in mental health?
  • A psychiatrist who is deeply comfortable with pediatric medical complexity?
  • A hybrid clinician in integrated or consult roles?
• Do I prefer:
  • Academic medicine with teaching and research?
  • High-volume clinical work in community settings?
  • Private practice with more autonomy and business responsibilities?

Your answers guide which positions—and compensation structures—will be most appealing.

6.2 Use Salary Data Thoughtfully

When you review national doctor salary by specialty reports:

• Remember they rarely list peds psych residency or triple board physicians as a separate line.
• Focus instead on:
  • General pediatrics
  • Adult psychiatry
  • Child & adolescent psychiatry
  • Your region’s cost of living
• Interpret these numbers as ranges, not guarantees.

When interviewing, ask specifically:

• “How is this role classified for compensation—under pediatrics, psychiatry, or a hybrid scale?”
• “Which CPT codes are most commonly used, and how does that translate into RVUs or compensation?”
• “How is time for integrated care and coordination valued and reimbursed?”

6.3 Learn Basic Contract and Compensation Concepts Early

Even as a resident, it helps to understand:

• Base salary vs productivity bonus
• RVUs (relative value units) and how they drive compensation in some systems
• Benefits: retirement contributions, CME funds, parental leave, malpractice coverage
• Non-salary perks: loan repayment, sign-on bonus, relocation assistance

A slightly lower base salary with strong loan repayment and a healthy bonus structure may outperform a seemingly higher salary without those supports, especially early in your career.

6.4 Maximize Your Leverage as a Triple Board or Peds Psych Physician

Because your skill set is rare:

• Don’t be afraid to negotiate:
  • Salary band (pscyhiatry-based vs pediatrics-based)
  • Protected time for integrated care or program-building
  • Medical directorships (which often come with a stipend)
• Highlight how you:
  • Reduce fragmentation of care
  • Improve outcomes for complex, high-cost pediatric populations
  • Fill a recruitment gap (many institutions struggle to staff child psychiatry and pediatric behavioral health adequately)

Institutions often recognize the unique value of triple board physicians once it is clearly articulated.

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FAQs: Physician Salary and Careers in Pediatrics-Psychiatry

1. Is a triple board or peds psych residency considered one of the highest paid specialties?
No. In terms of physician salary by specialty, peds psych/triple board is typically middle of the pack—higher than many primary care roles (especially if psychiatry-heavy), but far below procedure-heavy surgical subspecialties that dominate the highest paid specialties lists. The value lies more in its versatility and growing demand than in absolute top-tier pay.

2. Will I make more money as a pediatrician or as a child psychiatrist after triple board training?
In most markets, child & adolescent psychiatry roles pay more than general pediatrics. If you structure your career to be psychiatry-heavy (e.g., outpatient child psych, consult-liaison roles, telepsychiatry), you’re likely to earn more than if you work primarily as a general pediatrician, even with your triple board background.

3. How does a peds psych or triple board doctor salary compare to a typical psychiatry salary?
If you work in a child psychiatry-focused role, your salary will often be similar to or slightly higher than standard psychiatry due to:

• Child psychiatrist shortages
• Willingness of institutions to pay premiums for your combined expertise

If you work in more pediatric-centric roles, your salary may mirror pediatrics more closely, unless you negotiate based on your psychiatric services and role complexity.

4. Should salary be a major factor in choosing a pediatrics-psychiatry pathway?
Salary matters, especially with educational debt, but it should be one of several factors:

• Peds psych and triple board offer:
  • Moderate-to-strong earning potential
  • Deep alignment with those passionate about child health and mental health
  • Exceptional flexibility across settings and roles
    If you are primarily motivated by maximizing income, surgical or procedural specialties might align better. If you are drawn to the interface of pediatrics and psychiatry, peds psych offers a sustainable and meaningful career with solid compensation and high demand.

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Choosing a peds psych residency or triple board pathway means embracing a unique blend of pediatrics and psychiatry. While it may not top the charts in doctor salary by specialty, it offers:

• Financially stable, often above-primary-care earnings
• High job security and negotiating power
• Rich, varied career options over the long term

For applicants who care deeply about child mental health and complex pediatric care, it’s a compelling, future-proof niche that balances purpose and pay.