At one of our recent psychiatry courses one of our faculty members came up to me and, in confidence, said about another psychiatrist, “See that guy over there, he makes over a million dollars a year in his practice.” After a pause he added, “But he usually works seven days a week.”

Several thoughts passed through my mind in quick succession, in roughly this order, “Wow, that is a lot of money! …Wow, seven days a week! …Why wouldn’t six … or five … or maybe even four days a week be enough?”

The focus of this article is not on how to make a million bucks a year. And it’s not about judging this particular psychiatrist’s choice – although I strongly hope he practices in a competent and ethical manner. Rather, my focus is on a situation that many psychiatrists face that is enviable, almost unprecedented in human history, and yet not easy to resolve.

The situation is this: many psychiatrists can work more and more… and then some more. There are few barriers to working more and, as a result, making more money.

One motivation is to treat the many patients who come seeking our help. Especially in the public setting, there is an unending stream of patients wishing to make appointments. You may confront clinic administrators looking at you with stern expectation or, perhaps, social workers looking at you with imploring expressions, all wishing that you see more patients. Some doctors could literally replicate themselves several times over, all be working concurrently, and still experience work overload.

Another motivation is to make more money. It’s hard to turn it down when it’s easily obtainable. For many psychiatrists in the US, (because of shortages in many parts of the country), the external constraints to increasing one’s practice size and one’s income have receded. The better and more attuned you are to your patients, the more they want to send their friends and family your way.

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So the unexpected dilemma many psychiatrists confront now is that the amount of time they devote to their practices is very much up to them and no one else. External conditions (such as, for example, an overabundance of patients who want our help) have conspired with internal motivations (as, for example, the desire to make more money and a desire to accommodate patients clearly in need) to push many psychiatrists into a condition of overwork.

My goal in this article is NOT to suggest that you say ‘No’ to more patients or to more income, or to suggest that you should work less. After all, I don’t know your particular situation. Rather my goal is for you to ask yourself what it is that you WANT out of your practice and your life – and then align what you do, with what you want.

Remember and accept that the world will always want more of you than you can possibly give. It may bully you, guilt you, or seduce you into giving more of yourself than you can sustain in the long term. There is only one person – You! – in a position to decide when enough is enough and to say with firmness, “No more!”

Take care. Until next time,

Dr. Jack


Put a Sock in It!

This is a phrase we hope not to hear too often in our lives. It means, “Quiet down!” and is prototypically used by a parent who is exasperated by their rambunctious and overly loud kids. Although it’s regarded as a blunt and even rude way for a parent to bring their kids into line, it can be excused by the listener’s understanding that the parent is probably at their wit’s end. If anything, if we overhear a parent speaking this way, we would probably empathize with them. If used by an adult towards another adult or in a professional setting, however, this saying would be regarded as extremely offensive.

Now to the origin of this phrase: When recorded music became all the rage back in the latter part of the 19th century, Edison’s phonograph and Berliner’s gramophone lacked one crucial element—a volume knob. Thus, to modify the amplitude, woolen socks were stuffed in the horn or resonance box. Putting a sock in it was the ad-hoc volume control up ‘til the 1930s. The phrase stuck, and we still have it today.
Thanks much, and ‘til next time!