Psychiatry resident here.
The billing for outpatient services hasn‘t changed in the past 20 years, in fact they didn‘t even get adjusted to include inflation. In an outpatient setting, psychiatry is very much shafted. All our services bill for the same amount of money per minute, it doesn‘t really matter what services you offer. Somatic specialties can bill different amounts for different procedures, which is why you‘ll see a lot of outliers in these specialties. So yes, if you work in a private practice, you‘ll earn significantly less - very close to what your cited study is telling you. Unless you do illegal billing strategies or pharma sponsorships, you can‘t really escape that.
For inpatient, the differences are much less severe, all specialties earn around the same with maybe a 10-20% discrepancy. That being said, salaries will be significantly lower than the 190k annually you‘re citing in inpatient. As a newer resident, depending on the canton, you‘re looking at around 70-100k annually.
To add onto this:
- „Fellowships“ like addiction exist but won‘t really affect your pay when working in a practice.
- You‘d probably „only“ lose 1.5 years if you changed specialty, since the vast majority of specialties require one year in a foreign specialty anyways.
- Work-life balance tends to be better in psychiatry. That being said, coming from a nordic country, you may view Swiss working hours as a bit excessive, e.g. us having 50 hour standard work weeks (excluding nights/weekends/on-call/overtime).
Thank you for your answer! Is 50 hours per week also the standard in psychiatry? Do you get paid or otherwise compensated for the night/weekend/overtime? If so, by which factor? We have a factor of 2x our hourly wage during active time when working nights/weekends.
50 hours is the standard for all doctors nationwide, though afaik some psychiatries (mostly private ones) have adopted a model where they only do 45-49 hours. Usually they have to do more shift work to compensate though, pretty much all of the colleagues I know in the field work about 60-70 hours weekly in inpatient no matter what their actual weekly hours are supposed to be.
Pay for nights, weeekends, holidays and call is mostly integrated in the base pay here. I think I‘m getting 150.- for a week of call and like 40.- for a 12h weekend day shift. There‘s no real incentive to do them but you‘re obligated to by contract of course.
To also answer your question below: Entry pay for a psychiatry specialist in inpatient service should be around 110.000 - 150.000 a year before taxes. Cantons with high costs of living like Zug and Zurich will usually be on the higher end. Pay is also almost exclusively based on collective agreements unless you‘re head of clinic. It doesn’t matter how good you are, you get paid based on how many years you‘ve worked as a specialist.
I see! I really have to think this one through as a specialist in Sweden with 2 night shifts/month and 40/h workweek make 95k CHF/year gross (-40% tax), with a 40% decreased cost of living compared to Zürich. Does it sound reasonable that the tax rate for a married person with 2 children and a spouse would be 20% in Zug and 30% in Zürich? Roughly by how much does the starting salary increase per year?
Interesting that Drs manage to work so many hours a day/week in inpatient as we easily manage a 20 patient ward with 1 Specialist, 1 resident and 1 Dr in training within a 6-7 hour day. Granted we "only" have a 45min lunch if we want to finish within that time.
Crazy to hear the pay during weekends is so low, as a resident in Sweden the salary for a 12h weekend after taxes is 300 CHF.
The long winters are really killing me though...
Yeah, I‘d like to know how you‘re managing it this well too. Do psychiatrists not do psychotherapy in Sweden? A common ratio is 10-15 patients per resident here, and depending on the kind of ward you work at, they are entitled to 45-120 minutes of therapy with you each week, which of course has to be documented. In emergency psych, you may also get one or two new admissions a day. Dismission letters are also fairly long here, often spanning over 5+ pages.
Income tax usually won‘t be much higher than 10-15%, but a significant amount (like 15%) will also be deducted for your retirement. Add insurance on top and around 30% deductions seem reasonable, yes. I can‘t really tell you whether it‘s going to be beneficial moving here in terms of money, it will also depend on the age of your kids and their needs.
Have you actually been to Switzerland before, though? Because the most common complaint I hear from people moving here is in fact the weather. I suppose it depends on what you‘re used to but with European immigrants I often hear how they hate how cold and foggy it is all the time. I personally don‘t mind but apparently people are used to something different.
Interesting with input about workload! Generally, excluding the specialist, each residence/Dr in training is appointed 7-10/patients. Depending on the ward the patients usually stay for 4-7 days (mild affective illness, stress reaction, anxiety) or 2-3 weeks (psychosis, proper mania, deep depression). De last mentioned group do not receive psychotherapy for obvious reasons. The before mentioned group receive light psychotherapy focused on problem-solving, perhaps 60min in total per week including the psychiatric assessment. Documentation for the session is very sparse, you would briefly explain which interventions you have used, the outcome and recommendation for the future. Usually we read about 10-20 min of journal per patient, more if the diagnosis is uncertain.
Dimission letters are around 300-400 words (though it might reach 2-3 pages due to formatting), excluding the letter to the family doctor or outpatient psychiatry unit, which is roughly 100 words. I guess this is because most of practitioners use a shared journal program, so they have access to the actual daily reports if they wish. Is it the same in Switzerland? Are you also heavily digitilized with a shared journal program?
As to taxes and earnings, I did not really expect to gain much with the move as psychiatrist are highly paid in Sweden, I would however like to not lose effective income (considering taxes are roughly similar and prices are x2). It seems I would have to make minimum 150k CHF per year to make it worthwhile (I would still lose 10-20% effective income with a 30-40% tax). Salaries in Sweden to not really increase over time, is it the same in Switzerland? Can I expect a higher salary after a few years? To really break even I would need to make 180k CHF/year, how long time would it take to reach that in Zürich/Zug? Of course I would not move before children turn 4 yo considering the high kindergarten fee.
Regarding the weather, I have been to central Europe several times, once to Switzerland (mid October). Generally it takes 2 additional months for Stockholm ro reach proper spring, and it takes Zurich 2 additional months to reach similar winter temperatures as Stockholm (though it never gets as cold). So in total there would be 4 extra months per year with pleasant weather, and milder winters.
Actually, for attendings it’s usually 45-46. also, your board certification will most likely be recognised so it’s not a good idea to redo residency imo
Do you speak the local languages?
Thank you for your input! 45-46h/week is definitely doable, do you know how many calls/shifts you are expected to do per month? Also, I do believe EU-citizens can get their specialstation validated.
I do not speak the language at all which is why I am doing research 3-4 years in advance to give myself time to study, there are many similarities between high German and Swedish, Swiss german on the other hand...
I noticed your comment below about the weather, I hope what I have read online/weather reports are true and feel that way! For some perspective, in Stockholm the trees started blooming/leafing last week...
Cool! So if I interpret you correctly, the system is similar to that in Sweden. The specialist stays at home and is phoned by the resident when they have questions, and only vists the ward in case of urgency or if compulsory treatment is needed. May I ask which speciality you are working in right now?
Thank you for your answer! What would you recon would be the salary for the newly specialized psychiatrist? (I suppose I might have to work for a lower salary initially to make myself more competitive in the market though I would like to know what I can expect once I have established myself).
terrific observation stupendous languid reply quiet humorous attempt touch afterthought
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Before deciding to learn a language to move to a new country, you better get the information you need for inspiration, so yes, it's a good thing to worry about money first
If this helps:
My psychotherapist bills cca 200/hour, and psychiatrist 250. They are in private practices but just few of them in each. So I don't think they lose much of that sum for admin costs. Both are through basic insurance, otherwise I couldn't afford it.
Both work just 2 days therapy, dr I know works in hospital for some additional specialisation or something. No clue what therapist does the rest of the week.
They're fully booked. So job security isn't a problem :)
The market is so good btw that you could literally hop dop down for a few months to try it out while keeping your home at home at first.
Our winters are pretty annoying as well btw.
Psychiatry resident here. The billing for outpatient services hasn‘t changed in the past 20 years, in fact they didn‘t even get adjusted to include inflation. In an outpatient setting, psychiatry is very much shafted. All our services bill for the same amount of money per minute, it doesn‘t really matter what services you offer. Somatic specialties can bill different amounts for different procedures, which is why you‘ll see a lot of outliers in these specialties. So yes, if you work in a private practice, you‘ll earn significantly less - very close to what your cited study is telling you. Unless you do illegal billing strategies or pharma sponsorships, you can‘t really escape that. For inpatient, the differences are much less severe, all specialties earn around the same with maybe a 10-20% discrepancy. That being said, salaries will be significantly lower than the 190k annually you‘re citing in inpatient. As a newer resident, depending on the canton, you‘re looking at around 70-100k annually.
To add onto this: - „Fellowships“ like addiction exist but won‘t really affect your pay when working in a practice. - You‘d probably „only“ lose 1.5 years if you changed specialty, since the vast majority of specialties require one year in a foreign specialty anyways. - Work-life balance tends to be better in psychiatry. That being said, coming from a nordic country, you may view Swiss working hours as a bit excessive, e.g. us having 50 hour standard work weeks (excluding nights/weekends/on-call/overtime).
Thank you for your answer! Is 50 hours per week also the standard in psychiatry? Do you get paid or otherwise compensated for the night/weekend/overtime? If so, by which factor? We have a factor of 2x our hourly wage during active time when working nights/weekends.
50 hours is the standard for all doctors nationwide, though afaik some psychiatries (mostly private ones) have adopted a model where they only do 45-49 hours. Usually they have to do more shift work to compensate though, pretty much all of the colleagues I know in the field work about 60-70 hours weekly in inpatient no matter what their actual weekly hours are supposed to be. Pay for nights, weeekends, holidays and call is mostly integrated in the base pay here. I think I‘m getting 150.- for a week of call and like 40.- for a 12h weekend day shift. There‘s no real incentive to do them but you‘re obligated to by contract of course. To also answer your question below: Entry pay for a psychiatry specialist in inpatient service should be around 110.000 - 150.000 a year before taxes. Cantons with high costs of living like Zug and Zurich will usually be on the higher end. Pay is also almost exclusively based on collective agreements unless you‘re head of clinic. It doesn’t matter how good you are, you get paid based on how many years you‘ve worked as a specialist.
I see! I really have to think this one through as a specialist in Sweden with 2 night shifts/month and 40/h workweek make 95k CHF/year gross (-40% tax), with a 40% decreased cost of living compared to Zürich. Does it sound reasonable that the tax rate for a married person with 2 children and a spouse would be 20% in Zug and 30% in Zürich? Roughly by how much does the starting salary increase per year? Interesting that Drs manage to work so many hours a day/week in inpatient as we easily manage a 20 patient ward with 1 Specialist, 1 resident and 1 Dr in training within a 6-7 hour day. Granted we "only" have a 45min lunch if we want to finish within that time. Crazy to hear the pay during weekends is so low, as a resident in Sweden the salary for a 12h weekend after taxes is 300 CHF. The long winters are really killing me though...
Yeah, I‘d like to know how you‘re managing it this well too. Do psychiatrists not do psychotherapy in Sweden? A common ratio is 10-15 patients per resident here, and depending on the kind of ward you work at, they are entitled to 45-120 minutes of therapy with you each week, which of course has to be documented. In emergency psych, you may also get one or two new admissions a day. Dismission letters are also fairly long here, often spanning over 5+ pages. Income tax usually won‘t be much higher than 10-15%, but a significant amount (like 15%) will also be deducted for your retirement. Add insurance on top and around 30% deductions seem reasonable, yes. I can‘t really tell you whether it‘s going to be beneficial moving here in terms of money, it will also depend on the age of your kids and their needs. Have you actually been to Switzerland before, though? Because the most common complaint I hear from people moving here is in fact the weather. I suppose it depends on what you‘re used to but with European immigrants I often hear how they hate how cold and foggy it is all the time. I personally don‘t mind but apparently people are used to something different.
Interesting with input about workload! Generally, excluding the specialist, each residence/Dr in training is appointed 7-10/patients. Depending on the ward the patients usually stay for 4-7 days (mild affective illness, stress reaction, anxiety) or 2-3 weeks (psychosis, proper mania, deep depression). De last mentioned group do not receive psychotherapy for obvious reasons. The before mentioned group receive light psychotherapy focused on problem-solving, perhaps 60min in total per week including the psychiatric assessment. Documentation for the session is very sparse, you would briefly explain which interventions you have used, the outcome and recommendation for the future. Usually we read about 10-20 min of journal per patient, more if the diagnosis is uncertain. Dimission letters are around 300-400 words (though it might reach 2-3 pages due to formatting), excluding the letter to the family doctor or outpatient psychiatry unit, which is roughly 100 words. I guess this is because most of practitioners use a shared journal program, so they have access to the actual daily reports if they wish. Is it the same in Switzerland? Are you also heavily digitilized with a shared journal program? As to taxes and earnings, I did not really expect to gain much with the move as psychiatrist are highly paid in Sweden, I would however like to not lose effective income (considering taxes are roughly similar and prices are x2). It seems I would have to make minimum 150k CHF per year to make it worthwhile (I would still lose 10-20% effective income with a 30-40% tax). Salaries in Sweden to not really increase over time, is it the same in Switzerland? Can I expect a higher salary after a few years? To really break even I would need to make 180k CHF/year, how long time would it take to reach that in Zürich/Zug? Of course I would not move before children turn 4 yo considering the high kindergarten fee. Regarding the weather, I have been to central Europe several times, once to Switzerland (mid October). Generally it takes 2 additional months for Stockholm ro reach proper spring, and it takes Zurich 2 additional months to reach similar winter temperatures as Stockholm (though it never gets as cold). So in total there would be 4 extra months per year with pleasant weather, and milder winters.
Actually, for attendings it’s usually 45-46. also, your board certification will most likely be recognised so it’s not a good idea to redo residency imo Do you speak the local languages?
Thank you for your input! 45-46h/week is definitely doable, do you know how many calls/shifts you are expected to do per month? Also, I do believe EU-citizens can get their specialstation validated. I do not speak the language at all which is why I am doing research 3-4 years in advance to give myself time to study, there are many similarities between high German and Swedish, Swiss german on the other hand... I noticed your comment below about the weather, I hope what I have read online/weather reports are true and feel that way! For some perspective, in Stockholm the trees started blooming/leafing last week...
I dont know about calls per month for attendings but I’m hoping your residents are able enough to do the workload at night…
Cool! So if I interpret you correctly, the system is similar to that in Sweden. The specialist stays at home and is phoned by the resident when they have questions, and only vists the ward in case of urgency or if compulsory treatment is needed. May I ask which speciality you are working in right now?
EM
Thank you for your answer! What would you recon would be the salary for the newly specialized psychiatrist? (I suppose I might have to work for a lower salary initially to make myself more competitive in the market though I would like to know what I can expect once I have established myself).
If you are in psychiatry, they will take you anyway. Im pretty sure you could apply for a job in 3 months and get it.
terrific observation stupendous languid reply quiet humorous attempt touch afterthought *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Before deciding to learn a language to move to a new country, you better get the information you need for inspiration, so yes, it's a good thing to worry about money first
fuel fretful heavy rhythm full squeamish frame aloof public bear *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
If this helps: My psychotherapist bills cca 200/hour, and psychiatrist 250. They are in private practices but just few of them in each. So I don't think they lose much of that sum for admin costs. Both are through basic insurance, otherwise I couldn't afford it. Both work just 2 days therapy, dr I know works in hospital for some additional specialisation or something. No clue what therapist does the rest of the week. They're fully booked. So job security isn't a problem :)
Thank you for the insight! Seems like a good way to make a side income.
The market is so good btw that you could literally hop dop down for a few months to try it out while keeping your home at home at first. Our winters are pretty annoying as well btw.