Understanding Physician Salaries in Medicine-Psychiatry: A Resident's Guide

Understanding Physician Salary by Specialty in Medicine-Psychiatry

Medicine-psychiatry (often called med psych residency or medicine psychiatry combined) sits at a unique crossroads of two very different—and increasingly important—specialties. When you are planning your residency and long-term career, one of the most practical questions is: How does compensation work for a med-psych physician compared with other specialties?

This guide walks through:

• Where med-psych fits in the broader doctor salary by specialty landscape
• How compensation compares to internal medicine and psychiatry individually
• Academic vs private practice vs hospital-employed pathways
• How specific practice niches (consult-liaison, integrated care, inpatient vs outpatient) influence earnings
• Key factors that move you closer to or away from the highest paid specialties range

The goal is to give you a realistic, data-informed framework so you can align your training and early career decisions with both your clinical interests and long-term financial goals.

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1. The Big Picture: Where Medicine-Psychiatry Fits in Physician Salaries

When people ask about physician salary by specialty, they are usually referring to annual compensation surveys such as Medscape, Doximity, or MGMA. These surveys generally do not list “Medicine-Psychiatry” or combined programs as a separate category. Instead:

• Med-psych graduates are usually classified under:
  • Psychiatry
  • Internal Medicine
  • Hospital Medicine
  • Or occasionally Consultation-Liaison (C-L) Psychiatry or Primary Care depending on their actual job description

Because of this, it’s more accurate to think of medicine-psychiatry salaries as a range within the overlapping income brackets of internal medicine and psychiatry, modified by:

• Setting (academic vs community vs VA vs private group)
• Mix of inpatient vs outpatient
• Percentage of time spent on medicine vs psychiatry services
• Administrative or leadership roles

General Salary Benchmarks (Approximate, US, pre-tax, full-time)

Numbers vary by region and year, but as of recent national surveys (2023–2024 ballpark):

• General Internal Medicine:
  • ~$270,000–$320,000/year
• Hospitalist (Internal Medicine):
  • ~$290,000–$350,000/year
• Adult Psychiatry (outpatient-heavy):
  • ~$260,000–$330,000/year
• Consult-Liaison Psychiatry:
  • Often in the upper psychiatry range or slightly higher, ~$280,000–$350,000+
• Highest paid specialties (for comparison):
  • Orthopedic surgery, cardiology, dermatology, GI, radiology etc., often well above $450,000–$600,000+

Where does Medicine-Psychiatry land?

Most med-psych physician roles cluster around upper psychiatry to mid internal medicine income levels, with common ranges in the $275,000–$350,000+ bracket, depending heavily on:

• Work RVUs and productivity expectations
• Call requirements
• Location (urban academic vs rural community)
• Employed vs private practice structures

You are unlikely to match the highest paid specialties, but you typically sit above many primary care roles and comparable to or slightly above standard psychiatry jobs when your medical skillset is actively used and valued.

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2. Core Salary Drivers in Medicine-Psychiatry Careers

To understand your likely earnings, you need to know what drives compensation across combined medicine psychiatry roles. Four big factors dominate:

2.1 Clinical Focus: More Medicine, More Psychiatry, or Truly Hybrid?

Your doctor salary by specialty within med-psych is heavily affected by what you actually do day to day.

Common patterns:

1. Primarily Psychiatry with Medical Expertise (e.g., C-L psychiatry, integrated care)

   • Job is coded and billed mainly as psychiatry
   • Medical skills improve value but may not directly generate additional billing codes
   • Compensation tends to be on the higher end of psychiatry ranges, especially for:
     • C-L services
     • Complex medically ill psychiatric populations
   • Typical range: $280,000–$350,000+ depending on setting

2. Primarily Internal Medicine/Hospitalist with Behavioral Focus

   • Core role is hospitalist or internal medicine clinician
   • Extra training allows better management of delirium, substance use, complex behavioral issues
   • Pay often aligns with hospitalist or internal medicine compensation
   • Typical range: $290,000–$360,000+, sometimes higher in high-demand areas or high-intensity models

3. Balanced Dual-Role (e.g., 50% medicine, 50% psychiatry)

   • May split time between inpatient medicine teams and psych consult or inpatient psych units
   • Compensation structure can be:
     • Blended (negotiated midpoint between IM and psychiatry scales)
     • Weighted by time spent in each department
   • Many such physicians land in the $275,000–$340,000 range, but strong negotiation and high-need markets can push higher.

2.2 Employment Setting

Where you work influences your physician salary by specialty as much as what you do clinically.

1. Academic Medical Centers (AMCs)

   • Pros: teaching, research support, interdepartmental collaboration
   • Cons: generally lower base pay, though some offer generous benefits/loan repayment
   • Med-psych physicians often serve as:
     • C-L attendings
     • Program or clerkship directors
     • Cross-appointed faculty in psychiatry and medicine
   • Typical salary:
     • Often 10–25% lower than equivalent community positions
     • Common range: $240,000–$310,000 (with wide regional variability)

2. Community Hospitals / Health Systems

   • Pros: higher salaries, often less bureaucracy than big academic centers
   • Common roles:
     • Hospitalist with psych focus
     • Behavioral health service line medical director
     • C-L psychiatrist employed by system
   • Salaries more often in $290,000–$370,000+ range, plus potential bonuses

3. VA and Public Sector / Safety-Net Systems

   • Pros: strong benefits, federal retirement (for VA), loan repayment opportunities, mission-driven work
   • Salaries: generally competitive with academic, sometimes better, but usually below high-paying private/community roles
   • Often $250,000–$320,000, but benefits can be very valuable long-term

4. Private Practice / Hybrid Models

   • Pure private practice med-psych is less common than pure psychiatry or internal medicine
   • More likely:
     • Group practices with integrated behavioral and primary care
     • Specialty clinics (e.g., psych + obesity medicine, addiction, complex chronic illness)
   • Income potential can exceed $400,000 if:
     • High patient volume
     • Efficient billing
     • Ancillary income (telehealth, consults, medical-legal work)

2.3 Geography and Market Demand

The familiar rules apply:

• Rural / Underserved areas

  • Higher salaries, aggressive sign-on bonuses, loan repayment
  • Med-psych skill set is greatly valued due to limited access to both internists and psychiatrists
  • Offers in the $325,000–$400,000+ range for combined or flexible roles are not uncommon

• Urban, desirable metro areas

  • Lower base salaries, but more academic and specialty opportunities
  • More competition, more lifestyle-oriented roles
  • Often in the $250,000–$320,000 range for early-career physicians

2.4 Academic, Administrative, and Leadership Roles

Due to the cross-disciplinary nature, med-psych physicians frequently move into leadership:

• C-L service directors
• Integrated behavioral health program leaders
• Department vice chairs covering cross-cutting services
• Training program directors (med-psych residency, C-L fellowship)

These roles can bring additional stipends or salary increments, often:

• +$10,000–$50,000/year depending on scope
• Sometimes more at system level (service line chair, CMIO/behavioral health, etc.)

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3. Comparing Med-Psych With Psychiatry, Internal Medicine, and Highest-Paid Specialties

To gauge the value of a med psych residency, it helps to see where it stands relative to neighboring fields and the broader doctor salary by specialty spectrum.

3.1 Medicine-Psychiatry vs Psychiatry Alone

Psychiatry (general adult, outpatient-heavy):

• Typical compensation: $260,000–$330,000
• Lifestyle: favorable; often 40-hour weeks, limited call, telehealth growth
• Demand: extremely high nationwide

Medicine-Psychiatry in psychiatry-focused roles:

• Often paid at the upper end of psychiatry scales, especially if:
  • Doing C-L psychiatry
  • Managing medically complex psychiatric inpatients
  • Leading integrated care programs
• Hospitals are often willing to pay more for:
  • Reduced consult load on medicine teams
  • Better management of delirium, withdrawal, psychosis in medically ill patients

In real terms:
If you specialize in psychiatry-heavy practice, med-psych training often allows you to negotiate:

• Modestly higher base salary
• More protected time for complex consultation
• Leadership roles (with stipends)

…but not a dramatic difference vs a well-positioned psychiatrist in a high-demand location.

3.2 Medicine-Psychiatry vs Internal Medicine / Hospitalist

General Internal Medicine / Hospitalist:

• Hospitalist: $290,000–$350,000+ is typical
• Outpatient IM: $270,000–$320,000 with big regional variation
• Workload: often more intense, nights/7-on–7-off for hospitalists, higher RVU push

Medicine-Psychiatry doing medicine-focused work:

• Can match or slightly exceed general IM pay where behavioral complexity is high (e.g., medically complex addiction, severe mental illness with chronic disease, dual diagnosis units)
• You may trade:
  • Slightly lower RVU volume for higher case complexity
  • More time managing behavioral issues in hospital (which saves the system money and improves safety)

If you enjoy inpatient medicine but want a niche that respects your psychiatric skills, med-psych can yield similar or slightly better financial outcomes with more interesting, specialized work.

3.3 Medicine-Psychiatry vs the Highest Paid Specialties

High-end fields like:

• Orthopedic surgery
• Interventional cardiology
• Gastroenterology
• Dermatology
• Radiology
• Ophthalmology

…are often solidly in the $500,000+ range, with some exceeding $700,000 or more, especially with ownership in outpatient surgical centers.

Medicine-psychiatry will not typically compete directly with these highest paid specialties in raw earning potential. However:

• Training time is typically shorter than many surgical subspecialties
• Malpractice premiums and procedural stress are generally lower
• Lifestyle flexibility is often much better
• There is substantial room for non-clinical income (administration, consulting, telepsychiatry, teaching, policy roles)

If your primary goal is maximum lifetime income, you might look toward procedural specialties. If your priorities balance income with lifestyle, intellectual flexibility, and cross-disciplinary impact, med-psych compares favorably.

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4. Practical Examples of Med-Psych Career Tracks and Salaries

To make all of this more concrete, here are illustrative (not guaranteed) scenarios. Exact physician salary by specialty figures will vary by geography and institution, but the patterns remain consistent.

Example 1: Academic C-L Psychiatrist With Med-Psych Training

• Setting: Tertiary academic medical center
• Role:
  • 60% consultation-liaison psychiatry (primarily on medicine/surgery floors)
  • 20% med-psych clinic focusing on complex somatic symptom and functional disorders
  • 20% teaching and program development
• Salary:
  • Base: ~$265,000–$300,000
  • Small leadership stipend: +$10,000–$20,000
• Notes:
  • Lower than community pay but offset by academic career growth
  • High job security, prestige, and research opportunities

Example 2: Community Hospitalist With Behavioral Focus

• Setting: Community hospital system, mid-sized city
• Role:
  • 7-on/7-off hospitalist schedule, but specifically the “complex behavior” service:
    • Patients with severe mental illness, substance use, complex withdrawal, delirium
  • Serves as liaison to psychiatry team
• Salary:
  • $320,000–$370,000+ base, with productivity bonuses
  • Potential additional stipend for quality improvement leadership
• Notes:
  • Compensation similar or slightly higher than non-med-psych hospitalists
  • Hospital leadership values reduced sitter use, better throughput, fewer complications

Example 3: Integrated Care / Collaborative Care Director

• Setting: Large multi-site primary care network
• Role:
  • Oversees behavioral health integration in primary care, including telepsychiatry
  • 50% clinical (psychiatric consultations, e-consults, case reviews)
  • 50% administrative (program building, QA, education)
• Salary:
  • $280,000–$340,000 total compensation
• Notes:
  • Heavy on population health; fewer traditional RVUs
  • Strong potential for career growth into system-level leadership

Example 4: Niche Private Practice with Dual Focus

• Setting: Suburban outpatient clinic, physician-owned group
• Role:
  • Runs a specialty clinic focused on obesity, metabolic disease, and mood disorders
  • Offers combined medical management, psychiatric evaluation, and integrated therapy
• Salary:
  • Highly variable; potential net income: $350,000–$450,000+ depending on panel size, payer mix, and efficiency
• Notes:
  • Greater business risk but much higher autonomy
  • Value proposition is unique: patients get comprehensive care that few others can provide

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5. How to Maximize Your Earning Potential as a Med-Psych Physician

Even within the constraints of non-surgical specialties, you have substantial control over your income trajectory.

5.1 Make Strategic Choices During Training

During your med psych residency:

• Seek robust C-L exposure
  • This is one of the most marketable niches
  • Build comfort with delirium, neurocognitive disorders, complex polypharmacy
• Learn billing and RVU basics early
  • Understand differences between psychiatry and internal medicine billing
  • Ask attendings to explain codes during clinic and inpatient consults
• Get involved in integrated care projects
  • Quality improvement in collaborative care
  • Pilots that demonstrate cost savings and reduced readmissions

Programs that produce graduates who understand value-based care and cross-disciplinary leadership make you far more attractive—and thus better paid—later.

5.2 Choose a Practice Model That Rewards Your Skill Set

Compensation is highest where your dual capability is clearly monetizable:

• Roles where your med-psych training:
  • Reduces the need for multiple consults
  • Improves throughput and reduces length of stay
  • Lowers readmissions or ED utilization
  • Manages high-cost, high-complexity patients

Examples:

• Hospital systems that operate dedicated “medical-psychiatry units”
• Academic centers with high volumes of medically complex psychiatric patients
• Population health–oriented systems that track cost savings and share gains with physicians

When interviewing, ask explicitly:

• “How do you currently handle medically complex psychiatric patients?”
• “What are your biggest pain points involving comorbid medical and psychiatric illness?”
• “How would my skill set change workflows or reduce costs?”

Then negotiate compensation that reflects your role in solving those problems.

5.3 Negotiate Beyond Base Salary

Many residents fixate on base numbers, but a comprehensive physician salary by specialty package includes:

• Sign-on bonuses
• Relocation reimbursement
• Loan repayment (employer or state/federal programs)
• Productivity or quality bonuses
• CME funds and time
• Protected academic time (in academic settings)

In high-need markets, total first-year package for a med-psych physician can exceed:

• $400,000+ when you factor in:
  • Base salary
  • Signing bonus
  • Loan repayment
  • Relocation/benefit value

5.4 Consider Long-Term Non-Clinical and Hybrid Income Streams

Medicine-psychiatry backgrounds are especially attractive for:

• Hospital leadership (chief of behavioral health, vice chair for clinical integration)
• Utilization review / insurance medical director roles
• Industry (pharma, digital health, integrated care platforms)
• Policy work (state or national mental health initiatives)
• Telepsychiatry platforms designing integrated care models

These often offer:

• Competitive salaries (sometimes matching or exceeding clinical income)
• Predictable hours
• Geographic flexibility (for tele or corporate roles)

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6. Putting It All Together: Is Med-Psych “Worth It” Financially?

From an economic standpoint, a medicine psychiatry combined pathway offers:

• Income generally comparable to or slightly above:
  • Pure psychiatry
  • General internal medicine
• Substantial upside if:
  • You leverage high-demand niches (C-L, integrated care, hospitalist-behavioral roles)
  • You’re willing to work in rural/underserved or highly complex tertiary settings
• Less ceiling compared to procedural highest paid specialties, but:
  • Often better work-life flexibility
  • Lower burnout in well-designed roles
  • Unique career options in leadership and systems design

For a residency applicant in the RESIDENCY_MATCH_AND_APPLICATIONS phase, the key is not to chase a single number but to:

1. Understand the salary landscape honestly
2. Choose a med psych residency that supports your desired practice model
3. Build marketable skills that let you negotiate from a position of real value

With thoughtful planning, a med-psych career can deliver a strong physician salary, a flexible lifestyle, and deeply impactful work with some of the most complex patients in healthcare.

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FAQ: Medicine-Psychiatry Physician Salary and Careers

1. Do med-psych physicians get paid more than general psychiatrists?
Often, but not always. In roles where their medical skills are actively used—such as C-L psychiatry, medical-psychiatry units, or integrated care leadership—med-psych physicians can land at the upper end of psychiatry salary ranges or slightly above. In straightforward outpatient psychiatry roles, pay may be similar to general psychiatrists, with the main advantages being clinical versatility and career flexibility rather than a huge pay gap.

2. How does a med psych residency affect my future doctor salary by specialty?
It positions you at the intersection of internal medicine and psychiatry, which opens doors to roles that a single specialty may not qualify you for. Compensation tends to align with whichever side of your practice is dominant (medicine vs psychiatry), but your dual training makes you more competitive for leadership, C-L, and integrated care positions, which can come with higher total compensation and administrative stipends.

3. Can a medicine-psychiatry physician reach the highest paid specialties income levels?
It is uncommon to reach the income levels typical of orthopedic surgery, interventional cardiology, or GI through clinical med-psych work alone. However, some physicians approach or surpass high-end salaries by combining:

• High-demand clinical niches (e.g., complex inpatient C-L in a top-paying region)
• Private or group practice with a strong business model
• Administrative leadership or consulting work
  This requires entrepreneurship and strategic career choices rather than relying solely on standard employed positions.

4. Is med-psych a good financial choice if I value work-life balance?
Yes, for many people. While it typically will not match the maximum incomes of procedural specialties, medicine-psychiatry offers solid mid-to-high compensation with significant control over your schedule and practice design. Psychiatry-focused roles, in particular, can offer excellent work-life balance. Additionally, the breadth of your training allows you to pivot between inpatient, outpatient, academic, administrative, and telehealth work over the course of your career, which can help sustain both income and job satisfaction long-term.