Psychiatrist Salary Guide 2026: Pay by Setting, Cash-Pay Practice, TMS Revenue & NHSC

Psychiatry faces the most severe access crisis of any physician specialty in the United States — an estimated 60% of U.S. counties have no practicing psychiatrist, and the demand gap has widened significantly since 2020. Psychiatrist compensation has improved as a result of this structural shortage, but the specialty still earns less than most procedural fields and many internal medicine subspecialties. In 2026, employed psychiatrist compensation ranges from $260,000–$380,000, while cash-pay private practice psychiatrists — particularly those integrating TMS programs or ketamine services — can earn $400,000–$600,000 or more. This guide covers salary benchmarks by setting and practice model, the income impact of TMS and neuromodulation programs, telepsychiatry compensation, and the NHSC loan repayment landscape for psychiatrists serving underserved communities.

Psychiatrist salary by setting and practice model

• Employed psychiatrist (health system / community mental health): $260,000–$380,000; salary + productivity bonus; inpatient, outpatient, or partial hospitalization program (PHP/IOP) settings; health systems have been the largest employer of psychiatrists as independent private practice has become operationally challenging
• Insurance-based private practice (solo or group): $280,000–$400,000; higher ceiling than employed due to full professional fee retention; panel management and billing administration add overhead; many insurance-accepting psychiatrists limit their panel size due to low Medicaid and Medicare reimbursement rates relative to time investment
• Cash-pay / direct-pay private practice: $300,000–$500,000+; patients pay out-of-pocket ($200–$450/session for 45–60 min psychopharmacology visit; $100–$250 for 20-min medication management); eliminates insurance billing complexity; allows flexible scheduling and focused case selection; concentrated in affluent urban and suburban markets; the highest-earning model per clinical hour for most psychiatrists
• Telepsychiatry (platform-employed or 1099 contractor): $260,000–$390,000 employed; $200–$300/hour as 1099 contractor; major platforms (Teladoc, MDLive, Brightside, SonderMind, Talkiatry) contract psychiatrists; geographic flexibility; overnight and weekend coverage commands premium; state licensure in multiple states expands addressable patient base
• Academic psychiatry: $220,000–$310,000; medical school faculty; residency and fellowship training program leadership; research-protected time; NIH grant supplementation for investigators in translational neuroscience, psychopharmacology, and clinical trials; lower nominal pay but strong career development platform
• Child and adolescent psychiatry (CAP fellowship-trained): $280,000–$400,000; most severe subspecialty shortage in all of psychiatry; pediatric inpatient, outpatient, school-based, and emergency consultation; NHSC loan repayment especially competitive for CAP physicians in underserved communities
• Forensic psychiatry (fellowship-trained): $280,000–$420,000; competency evaluations, criminal responsibility assessments, civil commitment proceedings, correctional psychiatric care; state courts, correctional facilities, and expert witness work; government employment (corrections) offers pension and stability
• Addiction medicine / substance use disorder (SUD): $260,000–$380,000; buprenorphine prescribing for OUD, alcohol use disorder management, stimulant use disorder; MAT programs, FQHCs, and addiction medicine clinics; NHSC-eligible sites highly accessible in this subspecialty
• Geriatric psychiatry (fellowship-trained): $270,000–$390,000; dementia behavioral management, late-life depression, geriatric inpatient consultation; concentrated in academic centers and memory care programs; aging population driving demand
• Correctional psychiatry: $260,000–$380,000; state and federal prison psychiatric care; government employment with pension; complex patient population (comorbid SUD, trauma, severe mental illness); competitive pay with stability

Transcranial Magnetic Stimulation (TMS) practice revenue

TMS is one of the most significant ancillary revenue opportunities for private practice psychiatrists in 2026:

• Clinical indication: FDA-approved TMS is covered by most major insurers for treatment-resistant major depressive disorder (MDD) and OCD; typical acute treatment course is 36 sessions over 6–9 weeks; maintenance treatments follow
• Revenue per patient course: Each treatment course generates approximately $8,000–$15,000 in insurance-paid professional fees (CPT 90867–90869 for the psychiatrist's supervision and adjustment services) plus technical component fees if the practice owns the TMS device
• Equipment cost and ROI: TMS equipment (NeuroStar, BrainsWay, Magstim, Cloud TMS) costs $70,000–$120,000 new; monthly service contract adds $1,000–$2,500; a practice treating 3–5 TMS patients simultaneously (each receiving multiple sessions/week) typically achieves ROI within 12–24 months and generates $150,000–$400,000/year in annual TMS revenue after equipment financing
• Staffing model: A trained TMS technician or psychiatric nurse administers and monitors most TMS sessions; the supervising psychiatrist's direct time per patient is limited to initial evaluation, treatment planning, and progress reviews; this creates a highly efficient ancillary revenue model with minimal per-session physician time
• Accelerated TMS (SAINT protocol): Stanford-developed intensive TMS protocol (10 sessions/day for 5 days); some practices implementing accelerated TMS as a direct-pay premium service ($8,000–$15,000 cash for the 5-day intensive); FDA breakthrough device designation driving awareness

Ketamine and Spravato (esketamine) programs

• Spravato (esketamine nasal spray): FDA-approved for TRD and MDD with suicidal ideation; administered in-office under 2-hour observation; billing through J-code system; $500–$900 per session; psychiatrists integrating Spravato into their practice generate meaningful ancillary revenue with structured reimbursement
• IV ketamine (off-label): Psychiatrists supervising ketamine infusion programs (or collaborating with anesthesiologists for IV administration) can integrate direct-pay IV ketamine for TRD, PTSD, chronic pain; $400–$800/infusion, cash-pay; 6-infusion induction series typical; high patient demand in markets with established ketamine awareness
• Scope note: IV ketamine administration requires infusion infrastructure and anesthesia collaboration or specific training; Spravato is more readily integratable into standard outpatient psychiatry; regulatory requirements vary by state

ECT (electroconvulsive therapy)

Electroconvulsive therapy remains an important treatment for severe refractory depression and catatonia. ECT-trained psychiatrists earn additional procedural income:

• ECT billing: Each ECT session generates $150–$350 in professional fee revenue (CPT 90870); with anesthesia, hospital facility fees, and nursing coverage, the total procedure cost is $500–$1,500/session; the treating psychiatrist's professional fee is modest per-session but can add $40,000–$80,000/year for active ECT practitioners doing 2–3 sessions/week
• Inpatient vs. outpatient ECT: Most ECT is administered in hospital-based settings with anesthesia support; some ambulatory ECT programs operate in outpatient surgery centers; the treating psychiatrist's scheduling and anesthesia coordination requirements add administrative overhead

NHSC loan repayment for psychiatrists

Psychiatry is one of the highest-priority NHSC shortage specialties — more so than any other physician specialty except primary care:

• NHSC Loan Repayment Program: Up to $50,000 tax-free for 2 years of service; psychiatrists at FQHCs, CMHCs, rural mental health centers, and tribal health programs qualify; for psychiatrists with $200,000+ in loan debt, the NHSC 2-year commitment can provide more net financial value than the income premium of a cash-pay private practice position
• NHSC Students to Service: Up to $120,000 for medical students in their final year committing to 3 years of shortage-area service; psychiatric subspecialty training can be completed during the service period at qualifying sites
• State behavioral health loan repayment: Many states run parallel programs targeting psychiatry specifically — California, New York, Texas, and rural Western states have funded psychiatry-specific loan repayment to address chronic shortages
• PSLF (Public Service Loan Forgiveness): Psychiatrists employed at nonprofit health systems, government hospitals, or academic medical centers can pursue 10-year PSLF; especially valuable for academic psychiatrists and public sector practitioners with high loan burdens

Geographic variation in psychiatrist compensation

• Coastal metros (NYC, LA, San Francisco, Boston, Seattle): $300,000–$450,000 employed; cash-pay private practice can reach $500,000+ in affluent markets; high cost of living partially offsets; dense psychiatric population enables viable cash-pay panels
• Sun Belt (FL, TX, AZ): $280,000–$420,000; growing metropolitan markets; telepsychiatry platform concentration; rural FL/TX especially short; NHSC available in rural shortage areas
• Rural / underserved markets: $270,000–$400,000 base + NHSC + state supplement; some rural areas offering $50,000–$80,000 in combined loan repayment to attract the region's only psychiatrist; telepsychiatry increasingly the model for remote rural coverage
• Midwest academic centers: $250,000–$340,000 academic; strong research programs at Mayo Clinic, University of Minnesota, Ohio State, Vanderbilt; PSLF-eligible if 501(c)(3) employed

What we see at Ava Health

Psychiatry shortages are the starkest of any specialty in our client base — facilities regularly report 12–18 month waits to recruit a psychiatrist in competitive markets, and rural health systems often can't recruit at all without substantial financial incentives. Telepsychiatry has partly addressed the access gap for patients but has not eliminated the demand for in-person psychiatric capacity, particularly for inpatient programs and ECT-dependent treatment. The TMS revenue model is increasingly on the radar of private practice psychiatrists as a way to materially improve practice income without the billing complexity of adding cosmetic procedures or direct-pay models — for psychiatrists with suitable patient volume, a TMS program can add $150,000–$300,000 in annual revenue within 18 months of launch.

Related: PMHNP Salary Guide, Nurse Practitioner Salary Guide, Internal Medicine Physician Salary Guide, Physician Assistant Salary Guide.