Psychiatry Residency: A Comprehensive Guide to Physician Salaries

Understanding Physician Salary by Specialty in Psychiatry

Physician salary by specialty is one of the most misunderstood aspects of psychiatry as a career. Many applicants ask some version of the same question: “Is psychiatry one of the highest paid specialties?” or “Where does psychiatry fit on the doctor salary by specialty spectrum?”

For residency applicants preparing for the psych match, it’s important to understand not only how much psychiatrists earn, but also how salary varies across subspecialties, practice settings, and career stages. Unlike procedure-heavy fields, psychiatry’s income is driven more by visit volume, payer mix, and service model than by procedures and operating-room time.

This guide breaks down psychiatry compensation in a structured, residency-focused way so you can plan realistically while still prioritizing fit, interest, and long-term satisfaction.

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Where Psychiatry Fits in the Physician Salary Landscape

When people search for “physician salary,” they often see big, attention-grabbing numbers from procedural fields, and then assume all specialties are similar. In reality, there is a clear pattern in doctor salary by specialty:

• Highest paid specialties (often procedural and surgery-heavy) tend to include:

  • Orthopedic surgery
  • Plastic surgery
  • Cardiology (especially interventional)
  • Gastroenterology
  • Dermatology
  • Radiology and anesthesiology

• Mid-range compensation specialties often include:

  • Emergency medicine
  • General surgery
  • Neurology
  • Hospitalist internal medicine

• Lower-to-mid compensation specialties (still very high compared to general workforce salaries) often include:

  • Psychiatry
  • Family medicine
  • Pediatrics
  • General internal medicine

Psychiatry is not usually among the single highest paid specialties, but it consistently sits in a competitive mid-range among cognitive (non-procedural) fields. More importantly, when you factor in:

• Shorter or more controllable work hours
• Lower malpractice costs
• Rare overnight in-house calls (in many practice models)
• High flexibility for telehealth and part-time work

…the lifestyle-adjusted compensation in psychiatry becomes highly attractive, especially for applicants who value work–life balance and diverse practice options.

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Core Drivers of Psychiatry Compensation

Three big frameworks shape psychiatry income:

1. Training Level & Career Stage
2. Practice Setting & Employment Model
3. Subspecialty & Clinical Focus

We’ll walk through each with residency-relevant examples.

1. Training Level and Career Stage

Compensation evolves significantly from PGY-1 to senior attending years.

Residency and Fellowship

• Psychiatry residency salary (PGY-1 to PGY-4) is usually set by the institution, not by specialty.
• At most U.S. academic centers, PGY-1 salaries often fall in the low–to–mid $60,000s with gradual annual increases.
• Psychiatry residents are generally paid the same as internal medicine or surgery residents at the same hospital.

During fellowship, pay structure is similar—slightly higher than late residency, but still “trainee” level. Key points:

• PGY-5 and PGY-6 years (for child & adolescent, addiction, forensic, or other fellowships) are often in the high $60,000s to low $70,000s range, sometimes more in high-cost-of-living cities.
• Some fellows supplement income with moonlighting, which can be a major financial bridge toward attending-level earnings.

Early Attending Years (0–5 years in practice)

Transitioning from residency/fellowship to your first attending job is the biggest jump you’ll see in your physician salary. For psychiatry:

• New attendings may start around the lower range of typical psychiatrist salaries, then grow over the first 2–5 years based on:
  • Panel size / productivity (for RVU-based models)
  • Patient throughput and no-show rates
  • Negotiated raises and bonuses
  • Building reputation and referral streams

It’s common for early-career psychiatrists in employed roles to see total compensation increase by 10–20% over the first few years, assuming stable performance and good organizational fit.

Mid-to-Late Career

With seniority, psychiatrists can:

• Move into higher-paying subspecialty roles
• Take on leadership/admin positions (medical director, department chair, etc.)
• Shift into consulting, utilization management, or industry roles (pharma, health-tech, insurance)
• Grow private practices or group practices

These evolutions often bump overall compensation, even though base clinical salary might stay similar.

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Psychiatry Salary by Subspecialty: Who Earns What?

Within psychiatry, “physician salary by specialty” really means “by subspecialty and practice model.” Below are common psychiatry subspecialties and how they typically compare qualitatively. Specific numbers will vary by region, employer, and market conditions, but the relative patterns are consistent.

General Adult Psychiatry

• Role: Bread-and-butter outpatient care, inpatient units, partial programs, consultation-liaison on medical floors.
• Compensation range: Usually considered the “baseline” against which other psychiatric subspecialties are compared.
• Key income modifiers:
  • Outpatient vs. inpatient
  • Academic vs. community
  • Urban vs. rural/underserved
  • Telepsychiatry vs. on-site care

In many markets, rural or underserved areas may offer significant salary premiums, signing bonuses, or loan repayment programs for general psychiatrists, making them extremely competitive with higher-paying urban subspecialties.

Child & Adolescent Psychiatry

• Training: Typically 2 extra years of fellowship after a general psychiatry residency (though integrated tracks exist).
• Demand: Extremely high nationwide, especially in community settings.
• Compensation: Often higher than general adult psychiatry due to scarcity of specialists and high need.
• Practice models:
  • Outpatient clinics
  • School-based services
  • Telehealth with multistate licensure
  • Private practice focusing on ADHD, mood, and anxiety disorders

Child psychiatrists often have the ability to:

• Command premium reimbursement rates for evaluations
• Maintain waitlists, improving scheduling efficiency
• Negotiate flexible work arrangements (including fully remote roles)

Addiction Psychiatry

• Training: 1-year fellowship after psychiatry residency (or sometimes internal medicine or family medicine background).
• Practice:
  • Outpatient MAT (medication-assisted treatment) clinics
  • Dual-diagnosis inpatient units
  • Integrated primary care–behavioral health settings
  • Community mental health and public sector programs

Addiction psychiatrists can see a wide spread in salary depending on:

• Public vs. private sector
• Outpatient med management vs. intensive residential programs
• Medical directorship or program leadership roles

Because effective addiction treatment programs require strong physician leadership, many addiction psychiatrists secure stipends or salary bumps for director roles, which can significantly raise total compensation.

Forensic Psychiatry

• Training: Often a 1-year fellowship focusing on legal interfaces (competency evaluations, risk assessment, expert testimony).
• Work settings:
  • State hospitals and correctional facilities
  • Court-ordered evaluations
  • Independent medico-legal consulting

Forensic psychiatry can be quite lucrative, especially when:

• Doing private forensic evaluations (e.g., capacity, criminal responsibility)
• Providing court testimony as an expert witness
• Consulting for legal teams on complex psychiatric matters

Even those working primarily in public institutions may supplement income substantially through independent consulting, making forensic psychiatry one of the better-compensated niches within the field on a per-hour basis.

Geriatric Psychiatry

• Training: 1-year fellowship focusing on late-life mental health, neurocognitive disorders, and complex medical-psychiatric comorbidity.
• Practice models:
  • Nursing homes / SNFs
  • Memory clinics
  • Outpatient geriatric psychiatry clinics
  • Consultation in primary care or neurology settings

While geriatric psychiatry may not always be the very highest paying psychiatric subspecialty, it often offers:

• Stable, predictable patient populations
• Opportunities for consulting and medical directorship in long-term care organizations
• Growing demand due to aging populations worldwide

Consultation-Liaison (CL) Psychiatry

• Training: 1-year fellowship (formerly psychosomatic medicine).
• Practice:
  • Inpatient medical/surgical hospitals
  • Emergency departments
  • Integrated care programs

CL psychiatrists are often salaried at academic medical centers or large hospitals. While base pay may be similar to or slightly higher than general inpatient psychiatry, CL roles can become more lucrative with:

• Administrative supplements
• Leadership positions in service lines
• Grant funding or academic roles with protected time

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Practice Settings: How Your Job Type Shapes Your Income

For residency applicants entering the psych match, understanding where psychiatrists work and how they’re paid is just as important as subspecialty choice.

1. Academic vs. Community/Private Practice

Academic Psychiatry (University/Teaching Hospitals)

• Strengths:
  • Protected time for teaching, research, and leadership
  • Strong intellectual environment
  • Robust support services, multidisciplinary teams
• Compensation:
  • Often lower than community or private practice roles
  • Income may be partially offset by excellent benefits, retirement plans, and career development opportunities
• Salary drivers:
  • Rank (assistant, associate, full professor)
  • Administrative titles (program director, division chief)
  • Clinical bonus structures where available

Community / Private Practice Psychiatry

• Strengths:
  • Higher earning potential, especially in high-demand markets
  • Greater autonomy in scheduling and caseload composition
• Compensation:
  • Often higher base or higher potential total income relative to academic posts
  • Income can be more tightly tied to RVUs, collections, or panel size

If maximizing salary is a priority, a community or private practice path is more likely to approach the top of the psychiatrist earning spectrum.

2. Employed vs. Independent Practice

Employed positions (hospital systems, large groups, CMHCs):

• Usually include:
  • Base salary + potential RVU or quality bonus
  • Malpractice coverage
  • Health insurance and retirement contributions
  • Paid vacation and CME time
• Predictable and stable, ideal for early career psychiatrists still building clinical skills and financial literacy.

Independent/Private practice (solo or group):

• Income potential can be higher, especially for:
  • Cash-pay or hybrid practices
  • Niche expertise (e.g., forensic, OCD, ADHD, high-functioning autism)
• Trade-offs:
  • You manage overhead (rent, staff, billing, tech)
  • No built-in benefits; you must secure your own malpractice, health insurance, and retirement planning
  • Fluctuating revenue, especially in the early years

Over a full career, successful private practice psychiatrists often out-earn their employed peers, but they also shoulder more business risk and responsibility.

3. Telepsychiatry and Remote Work

Telepsychiatry has transformed the psych job market:

• Multi-state licensure and telehealth platforms let psychiatrists:
  • Reach high-demand areas without relocation
  • Work from home or flexible locations
  • Do part-time telepsych to supplement a primary job

Telepsychiatry compensation varies based on:

• W-2 vs. 1099 contractor status
• Per-hour vs. per-visit payment
• Volume expectations and scheduling control

For residents and fellows, moonlighting in telepsychiatry (if allowed by GME policies) can be a powerful way to:

• Test different practice models
• Build savings
• Gain comfort with outpatient management

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Lifestyle, Debt, and Long-Term Value: Beyond the Raw Numbers

When comparing doctor salary by specialty, it’s easy to line up fields by income alone and ignore everything else. This is a mistake, especially with psychiatry.

Work–Life Balance and Burnout Risk

Psychiatry is often chosen for:

• Relative schedule predictability
• Fewer or no overnight in-house calls (in most outpatient-focused jobs)
• The ability to work part-time or flexibly without huge penalties to salary

Compared to some of the highest paid specialties (orthopedics, neurosurgery, interventional cardiology), psychiatry typically offers:

• Shorter average workweeks
• Greater control over visit length and panel size
• More opportunities to adapt your practice as personal or family needs change

Loan Repayment and Financial Planning

Many psychiatry positions, particularly in:

• Community mental health
• Rural or underserved clinics
• VA or other federal/state systems

qualify for loan repayment programs, such as:

• National Health Service Corps (NHSC)
• State-specific loan forgiveness programs
• Public Service Loan Forgiveness (PSLF)

When you factor in $100k–$300k of loan repayment or forgiveness over several years, the effective physician salary can approach or exceed some higher-paying specialties that lack these benefits.

Non-Clinical and Hybrid Roles

Psychiatrists also have unique non-clinical income routes, including:

• Medical directorships for behavioral health programs
• Customer or clinical advisory roles for mental health startups
• Utilization review for insurers
• Pharma consulting, advisory boards, or research
• Writing, speaking, and education (CME, online courses)

These side roles often pay at a high hourly rate, letting you strategically boost overall income without dramatically expanding clinical hours.

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Practical Advice for Applicants: Aligning the Psych Match With Salary Goals

For residency applicants navigating the psych match, you don’t need to lock in a subspecialty now—but you should understand how early choices can shape future compensation.

1. Choosing Programs With Broad Exposure

Aim for psychiatry residency programs that offer:

• Robust exposure to:
  • Child and adolescent psychiatry
  • Addiction psychiatry
  • Forensic cases or rotations
  • CL and integrated care
• Opportunities to moonlight in later years:
  • Inpatient units
  • Crisis services
  • Telepsychiatry

Exposure helps you discover which clinical settings you enjoy and which might best align with your financial goals.

2. Learning the Business of Psychiatry Early

Even if you’re not planning private practice, basic financial literacy is critical:

• Understand RVUs, wRVUs, and how they translate to pay.
• Learn the difference between:
  • Base salary vs. productivity bonus vs. quality incentive
  • W-2 employed vs. 1099 contractor status
• Track your own productivity during residency to estimate how that might convert to real-world RVU targets.

Ask attendings how their contracts are structured and what they’d do differently if starting over.

3. Considering Geography Strategically

Geography is one of the most powerful levers in psychiatry compensation:

• High cost-of-living urban centers may have prestigious institutions but sometimes lower salary relative to cost-of-living.
• Rural or underserved regions:
  • Often offer significantly higher pay and generous signing bonuses
  • May include loan repayment and relocation assistance

If you’re flexible on location, you can trade geography for income and use early career years to aggressively pay down debt and build financial security.

4. Balancing Salary With Fit and Sustainability

While it’s important to understand where psychiatry stands relative to the highest paid specialties, most psychiatrists gravitate toward the field for its:

• Rich patient relationships
• Intellectual and interpersonal nature of the work
• Flexibility across clinical, academic, and consulting roles

For long-term career satisfaction:

• Don’t choose a subspecialty only for marginally higher pay.
• Consider your tolerance for certain patient populations (e.g., forensic, severe SUD, child/adolescent).
• Look at how different roles align with your personality, values, and desired day-to-day life.

Over a 30–40 year career, avoiding burnout and staying engaged with your work can matter as much as any salary differential you see in your first job’s offer letter.

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FAQs: Physician Salary by Specialty in Psychiatry

Is psychiatry one of the highest paid specialties?

Psychiatry is not typically in the very top tier of highest paid specialties like orthopedics, plastic surgery, or interventional cardiology. However, compared with other cognitive specialties (family medicine, general internal medicine, pediatrics), psychiatry is often competitive or higher, particularly in high-demand or underserved areas. When adjusted for lifestyle and work hours, psychiatry is frequently considered a very favorable specialty.

Which psychiatric subspecialty tends to pay the most?

It varies by region and practice model, but forensic psychiatry, child and adolescent psychiatry, and psychiatrists with strong private practice or consulting components often sit at the higher end of the psychiatry salary range. Forensic psychiatrists can command high hourly rates for medico-legal evaluations and testimony, while child psychiatrists often benefit from intense demand and limited supply.

Do academic psychiatrists earn significantly less than community or private psychiatrists?

In general, yes—academic psychiatry salaries tend to be lower than those in community or private practice, especially early in the career. However, academic roles also come with non-monetary benefits (teaching, research opportunities, institutional prestige) and often stronger benefits packages. Over time, leadership roles and consulting opportunities can help close some of the gap.

How can a psychiatry resident position themselves for higher future earnings?

Key strategies include:

• Seeking broad subspecialty exposure (child, addiction, forensic, CL) during residency.
• Understanding RVUs, productivity metrics, and basic contract structures.
• Moonlighting when allowed to gain experience and build savings.
• Considering geographic flexibility, especially early in your career.
• Learning about private practice and telepsychiatry, even if you don’t plan to pursue them immediately.

By combining thoughtful subspecialty choices, strategic geography, and a solid grasp of the business side of medicine, you can build a psychiatry career that is both personally fulfilling and financially secure.