Working in psychiatry
shrinkiatry is the profession lens, so this page lays out how independent and telepsychiatry practice actually compares for psychiatrists and PMHNPs, and where to go if you want to practice this way.
Who this is for
This page is written for two groups of clinicians: psychiatrists and psychiatric mental health nurse practitioners. If you're weighing a move out of high-volume employment, or you're early enough in your career to choose a model deliberately, this is for you. shrinkiatry doesn't sell a dream about independent practice. It explains how the models actually differ, so you can decide with clear eyes rather than on a recruiter's pitch.
The case for independent and telepsychiatry practice
The appeal of independent and telepsychiatry work isn't mainly the money, though the economics can be favorable. It's control. Setting your own panel size, deciding how long a visit runs, choosing your pace, and not answering to a productivity quota are the things clinicians most often say they were missing. Telepsychiatry adds reach: with licenses in more than one state, you can build a fuller, steadier schedule than a single local market allows. The model isn't for everyone, and it carries real pressures of its own, but for the right clinician it restores the parts of the work that the volume model takes away.
The economics, in plain terms
The dollars deserve honesty rather than hype. Insurance-free practice trades a contracted rate and a built-in referral stream for a higher per-visit fee, far less paperwork, and full responsibility for filling your own panel; we walk through that math in the economics of insurance-free psychiatry. Independent-contractor telepsychiatry pay comes in a few specific structures with reported ranges and real tradeoffs, which we lay out in what 1099 telepsychiatry pays. And the reason so many clinicians look for a different model in the first place is the subject of why the volume model burns clinicians out. Read all three before you decide anything.
What to look for in a practice
If you do move toward independent or telepsychiatry work, judge any practice or platform on four things. Autonomy: do you actually control your panel and your day, or is the quota just relabeled? Panel size: is it sane, or sized for throughput? Documentation support: does the setup keep charting from eating your evenings? And coverage: is malpractice provided, and if it's claims-made, is tail included? A model that gets these right is worth far more than a headline rate that doesn't.
An honest note
This is education, not a job listing. shrinkiatry exists to explain the profession, and the point of this page is to help you think clearly about how the models compare, not to push you toward any one employer. If you decide independent or telepsychiatry practice fits you, the market is wide and you should shop it carefully.
In the interest of full transparency: the editor of shrinkiatry founded shrinkMD, an independent multistate telepsychiatry practice mentioned below. That interest is spelled out on the disclosures page, and it's why this page stays focused on how the models compare rather than on selling one of them.