Psychiatrist salary in 2026 — what the median hides, pay by state and setting, and how to tell if you're underpaid

What a psychiatrist earns in 2026

The Bureau of Labor Statistics' May 2025 figures, released in 2026, put the median annual wage for psychiatrists at $281,870, or $135.51 an hour.¹² The mean is lower, at $269,940, because the bottom of the distribution is dragged down by trainees — more on that below. BLS counted 27,980 psychiatrists in its wage survey and projects the occupation to grow 7% between 2025 and 2035, against 4% for physicians as a whole.¹²

The physician compensation surveys, which only count practising attendings, all land higher. Medscape's 2026 report, drawn from 5,916 full-time physicians surveyed in late 2025, puts the average psychiatrist at $331,000.³⁴ Doximity's 2026 report, built on nearly 23,000 surveys through 2025, says $350,786.⁵ SalaryDr's self-reported database shows a median of $351,800 from 102 verified reports as of October 2026, and Marit Health's licensed benchmark data gives a median of $340,000 and a mean of $351,000 from 558 salaries.⁸⁹

Here is every headline figure in one place, with its date and what it is actually measuring.

One trend sits underneath all of this and deserves saying plainly. Medscape's 2026 report found psychiatry pay fell about 3%, from $341,000 to $331,000, in a year when physician compensation overall rose about 3%; psychiatry was one of nine specialties with flat or declining pay, up from seven the year before.³⁴ Doximity's data points the other way — $341,977 in its 2025 report to $350,786 in 2026, a rise of roughly 2.6%.⁵⁶ Two reputable surveys, two directions. The honest reading is that psychiatry pay has stopped climbing the way it did between 2021 and 2024, and that the premium now sits in specific settings, specific contracts and specific states rather than in the specialty as a whole.

Why the numbers disagree

A $70,000 gap between the BLS median and the Doximity average is not a rounding error. Four things explain it, and each one matters when you benchmark your own offer.

• BLS includes residents and fellows. The occupational code 29-1223 covers anyone employed as a psychiatrist, and psychiatry residents are classified there. That is why the 10th percentile is $84,060 — a resident's salary — and why the mean sits below the median.² Nobody who has finished training should benchmark against the BLS mean.
• BLS excludes the self-employed. Private-practice owners, who are among the highest earners in the specialty, are not in the OEWS sample at all.²
• BLS measures wages; surveys measure total compensation. Bonuses, profit share, call pay and RVU incentives are in the Medscape and Doximity figures. Marit's data suggests base is about 92% of total for psychiatrists, with bonuses around 5% and other income 3%.⁸
• Surveys select for people who answer surveys. Self-reported databases such as SalaryDr skew toward physicians who are engaged enough to type their salary into a website, and their samples are small — 102 reports is enough to be informative, not enough to be definitive.⁹

The BLS percentiles are still the best public picture of the full spread, as long as you read the bottom with the residents in mind.²

A practical rule: if you are three or more years out of residency and employed full time, the relevant national benchmark is the band between the BLS median ($281,870) and the survey averages ($331,000–$352,000). Below the BLS median, something about your setting, your hours or your contract is pulling you down, and the rest of this article is about finding out what.

Psychiatrist salary by state

State pay for psychiatrists is less tidy than for most occupations, because the samples in small states are tiny and BLS suppresses estimates where the data is thin. The table below gives both the median and the mean from the May 2025 release for the ten highest-paying states by median and the five largest employers of psychiatrists.² Where the two measures disagree sharply — Missouri, Alaska, Florida — treat the state figure as a wide range rather than a point.

Three things worth noticing.

1. The big-employment states are not the big-pay states, except California. New York, Texas and New Jersey together employ more than 7,000 psychiatrists and all three sit well below the national median. Part of that is the resident effect — New York trains an enormous share of the country's psychiatry residents, and they are in the wage sample — and part is simply supply.²
2. The Upper Midwest pays. Minnesota and Wisconsin are in the top five by median, and Marit's survey data shows the same pattern with Wisconsin at $363,500 average total compensation.²⁸ Doximity's 2026 report found the highest-paying physician metros overall were concentrated on the West Coast and in the Midwest.⁵
3. A high state median can still be a bad deal. California's $353,500 median comes with California's housing. Minnesota's $336,410 does not. If you are choosing between states, run the comparison on what is left after rent or a mortgage, not on the headline.

The survey data adds one state-level finding BLS cannot: Marit found rural psychiatrists averaging $359,000 against $340,000 in the largest metros.⁸ The premium for going where the shortage is sharpest is real but modest in salary terms; it is much larger in sign-on bonuses and loan repayment, covered below.

Pay by setting

Where you work moves your pay more than where you live. The BLS industry breakdown and the survey data agree on the shape, even where they disagree on the level.

Start with the BLS industry medians from May 2025, which cover employed psychiatrists only.²

The hospital and university medians look alarming until you remember that this is where the residents are. Teaching hospitals and medical schools employ most trainees, and the trainee salaries pull those industry medians down. For an attending, the survey data is the better guide.^89111213

Private practice has the highest ceiling and the widest floor. The SalaryDr average of $385,000 comes from twenty respondents, and Marit's self-employed average is $47,000 lower; both are total compensation before the owner pays for benefits, malpractice, rent and staff out of the gross.⁸⁹ A cash-pay practice in a dense urban market can clear far more than any employed role; a practice that takes commercial insurance and employs a biller may not clear the hospital salary down the road. There is no reliable public figure for cash-pay psychiatry fees, so be sceptical of anyone quoting one.

Hospital-employed and medical-group roles are where the money is for most psychiatrists who do not want to run a business, and they are also where RVU-based pay is most common — see the RVU section.⁸⁹

Community mental health centres and FQHCs pay less in base than the hospital market but are where the loan repayment lives. Marit's community and public health figure of $347,500 is higher than many clinicians would expect; it reflects the fact that CMHCs now compete for a scarce workforce and have raised base pay accordingly.⁸

The VA publishes its pay bands. For 2026, a Tier 1 staff psychiatrist sits in a band from $124,308 to $315,000; a Tier 2 supervisor or section chief tops out at $335,000 and a Tier 3 service chief at $350,000, effective 11 January 2026.¹³ The attraction is the federal pension, the benefits and the Public Service Loan Forgiveness eligibility, not the headline. Read the band ceiling as a hard cap, because it is one.

Telepsychiatry pays slightly below in-person employed work in the survey data — Marit puts retail clinic and telemedicine at $315,500 — but the larger telehealth employers are competitive: Indeed's aggregate of 1,862 postings for one national telepsychiatry company shows an average of $327,889, with a range from $164,000 to $494,000.⁸¹¹ The real variables are whether the role is W-2 or 1099, whether a no-show is paid, and the panel size. Remote psychiatrist jobs — where the openings are and how to get hired covers the market in detail.

Corrections is the setting most psychiatrists never price. California's correctional system filed 2026 wage ranges for correctional staff psychiatrists of $260,004 to $330,027, with a median of $286,980, before the overtime and differentials that state systems routinely add.¹² Other state systems publish their ranges in their own job postings; the pattern is a state salary at or above the hospital market, a state pension and a working environment that is not for everyone.

Academic roles sit about $20,000–$40,000 below the hospital market in both surveys, at roughly $340,000 total.⁸⁹ That gap is the price of protected time, trainees and a title. It is a reasonable trade if you use the protected time; it is a bad one if the department expects clinical productivity on top.

Pay by experience

Psychiatry has an unusually flat experience curve. The starting market is strong because demand is strong, and the mid-career premium is smaller than in procedural specialties.

Two sources, same shape.⁷⁸⁹ Marit shows roughly $31,500 between a new attending and one with more than eleven years; SalaryDr's bands are within a few thousand dollars of each other from year one to year sixteen. The AMN starting figure of $315,000 is an average of actual offers and rose from $285,000 the previous year — a 10% jump in one cycle — which tells you where the leverage is.⁷

The implication is uncomfortable for anyone fifteen years in: tenure alone will not raise your pay. What raises it, in the data, is changing setting, taking on a medical-director or leadership role (the BLS 90th percentile of $446,520 is largely that group), adding productivity or call pay, or moving to a market with a worse shortage.² A psychiatrist who has stayed in one employed role since 2018 on annual cost-of-living increases is very likely below the current starting offers in their own market, and the only way to find out is to look.

Subspecialty premiums

The honest answer on subspecialty pay is that the surveys do not show a consistent premium, and anyone quoting a precise one is working from a small sample.

Read across the rows and the picture is clear: in the larger sample, child and adolescent, addiction and geriatric psychiatrists all average less than general psychiatrists; in the smaller sample they average slightly more.⁸⁹ Neither shows the $50,000-plus fellowship premium that recruiting pages imply.

Why the fellowship still pays, in three places the salary surveys do not capture:

• Demand and sign-on. Child and adolescent psychiatry is the most persistently unfilled psychiatry search in the country, and employers respond with larger sign-on bonuses and relocation packages rather than higher base. That money is real but it is one-off.
• Forensic work is paid by the hour, outside the salary. Evaluations, expert testimony and court work are typically billed at hourly rates that are not in any salary survey. A forensic psychiatrist's W-2 can look ordinary while the 1099 side is substantial. There is no reliable public figure for forensic hourly rates, and we are not going to invent one.
• Addiction psychiatry opens a second market. Opioid treatment programmes, hospital addiction consult services and the medical-director roles that go with them are often filled by addiction-boarded psychiatrists and addiction medicine physicians at rates set by that market rather than the psychiatry salary scale. Addiction medicine physician jobs — where the openings are covers that market, including the medical-director track.

If you are choosing a fellowship for the money, the data says: do not. Choose it for the work, and then use the scarcity to negotiate the non-salary parts of the package.

Locum rates and the 1099 maths

CHG Healthcare's 2026 locum tenens pay data puts psychiatry at $220 to $250 an hour, up from $185 to $220 the year before — one of only eight specialties out of 33 whose range rose.¹⁰ That is consistent with what agencies have been advertising through 2026 and with the direction of the starting-salary market.

At those rates the gross looks enormous, and it is meant to. Here is the arithmetic that the agency pages leave out, using a mid-range $235 an hour.^10151617

So full-time locum work at 2026 rates beats the average employed package by roughly $40,000 a year — if you work 46 full weeks. The number that destroys the comparison is gaps. Every week between assignments costs $9,400 at this rate. Six unplanned weeks off, which is a normal year for a locum who is not willing to go anywhere, and the advantage is gone. Then add the practical costs the table cannot price: credentialing delays, travel days, a different EHR every three months, and the fact that psychiatry locum rates are quoted per hour, so an assignment that promises 40 hours and delivers 32 pays for 32.

The half of the self-employment tax that mirrors the employer's share is deductible, and a solo 401(k) lets a 1099 physician shelter far more than an employee's plan does, which narrows the gap further for anyone who is disciplined about it.¹⁶ The point is not that locum work is a bad deal. It is that the right comparison is the whole package, not $235 against $159 an hour, and that the agencies know you will not do the maths. The 1099-or-salaried rate maths walks through the same calculation step by step for behaviour analysts; the structure is identical for physicians, the numbers are just larger.

Where locum psychiatry clearly wins: as a supplement. Four extra inpatient shifts a month on top of an employed role, at locum rates, is the most reliable way a psychiatrist can add six figures without changing jobs — and because the employer is still covering benefits, nearly all of it is margin.

RVU pay and what a wRVU is worth

Medscape found that 21% of psychiatrists have quantifiable metrics such as RVUs directly affecting their base pay, and that 44% qualified for an incentive bonus averaging $32,000.³ Hospital and health-system contracts increasingly use a wRVU model, so it is worth understanding before you sign one.

What a wRVU is. Every CPT code carries a work relative value unit, set by CMS, that represents the physician effort in that service. Medicare pays the total RVUs (work, practice expense and malpractice) multiplied by a conversion factor, which for 2026 is about $33.40.¹⁵ Your employer, however, pays you a contract rate per wRVU that has nothing to do with the Medicare rate — it is negotiated, and it is where the money is.

The code values are from the 2026 CMS fee schedule files as compiled by a specialty RVU reference; CMS has been stepping up the psychotherapy add-on values since 2024, so check the current file for the add-on codes specifically.¹⁵

What the rate is worth. Marit's benchmark data puts the median contract rate for psychiatrists at $60 per wRVU, with the 25th percentile at $43 and the 75th at $65, and the median psychiatrist producing 4,500 wRVUs a year (25th percentile 3,953; 75th 5,831).⁸ Multiply the medians and you get $270,000 — which is why most wRVU contracts also carry a base salary or a guarantee for the first one to two years.

The worked example. Twelve medication-management follow-ups a day, mostly 99214 with the occasional 99213, averages about 1.7 wRVUs a visit. Over 4.5 clinic days and 46 weeks that is roughly 4,200 wRVUs — just under the median. Add a 90833 therapy add-on to half of those visits and the same schedule produces about 6,000 wRVUs; at $60 each the difference is $108,000 a year. That is the single largest lever in any productivity contract, and it is one most psychiatrists are never shown.⁸¹⁵

Four things to get in writing before signing a wRVU contract:

1. The dollar rate per wRVU, and whether it is tiered (a higher rate above a threshold) or flat. Anything below $50 is below the 25th percentile and needs a reason.⁸
2. The threshold you must clear before productivity pay starts, and how long the base guarantee runs. A threshold set at 5,500 wRVUs for an outpatient role with 30-minute slots is a target most psychiatrists will not reach.
3. Whether no-shows, documentation time and telephone work generate any credit. In pure wRVU models they do not, and a 20% no-show rate is a 20% pay cut.
4. Whether the CMS annual RVU changes flow through to you. If CMS revalues a code down, a contract pegged to "current CMS values" cuts your pay without anyone negotiating anything.

Sign-on bonuses and loan repayment

Because the starting market is tight, psychiatrists are offered more one-off money than almost any other non-procedural specialty. It is worth separating the kinds.

Sign-on bonuses. AMN Healthcare's 2025 review found average physician signing bonuses had risen 23% in a year, and psychiatry is consistently in its top tier of requested searches, which is where the larger bonuses sit.⁷ A psychiatry sign-on in the $30,000–$50,000 range is common in hospital and health-system offers, and higher in rural and child-and-adolescent searches. Two things to check: the clawback period (usually two to three years, pro-rated — ask whether it is pro-rated monthly or forfeited in full) and whether it is paid on signing or on start. A bonus you have to repay if you leave in year two is a retention device, not a gift; price it that way.

Federal loan repayment. The National Health Service Corps Loan Repayment Program pays up to $50,000 for a two-year full-time commitment by a behavioural-health physician at an approved site in a mental health professional shortage area, or $25,000 for half-time; a 2026 enhancement adds $5,000 for Spanish-proficient clinicians, and participants can apply for continuation contracts after the initial two years.¹⁴ The award is tied to the site, not the employer, so a CMHC or FQHC with an NHSC-approved site is worth asking about even if the job advert does not mention it.

Public Service Loan Forgiveness. VA, state, county and most non-profit hospital employment qualifies; most private-practice and physician-group employment does not. For a psychiatrist with $250,000 or more in federal loans, ten years of qualifying payments followed by forgiveness can be worth more than the entire salary difference between a VA post and a hospital post. Nobody will put that on the offer letter, so do the calculation yourself.

State programmes. Most states run their own loan-repayment schemes for psychiatrists in shortage areas, usually administered alongside the NHSC State Loan Repayment Program, with amounts and service terms that vary by state.¹⁴ Check the state you are moving to before you accept, because some require you to apply before you start.

How to tell if you are underpaid

Most psychiatrists who are underpaid do not know it, because the only salary they see is their own. Here is a check you can run in an hour.

1. Place yourself on the BLS distribution. Full-time, employed, three or more years out, and below the national median of $281,870? You are in the bottom half of a distribution that includes residents.² Below your state's median from the table above? Same conclusion, locally.
2. Compare to the starting market, not the average. AMN's average starting offer is $315,000.⁷ If a new graduate would be offered more than you earn, that is the clearest possible signal — and your employer knows it, because they are making those offers.
3. Check the setting band. Hospital-employed at $300,000 when the survey averages are $357,000–$379,000? Telepsychiatry at $250,000 when the survey average is $315,500?⁸⁹ A setting discount of $20,000 is normal; $60,000 is not.
4. Price the package, not the base. Add employer retirement contributions, the employer share of health premiums (around $20,000 for family cover on 2025 averages¹⁷), CME, malpractice and paid leave. Two offers $25,000 apart in base can be equal in total.
5. If you are on wRVUs, divide. Total compensation divided by your annual wRVUs is your effective rate. Below $43 you are at the 25th percentile; below $60 you are below the median.⁸
6. Look at the hours. Medscape's psychiatrists average 45 hours a week; Marit's about 42.³⁸ $331,000 for 45 hours is $141 an hour. $300,000 for 36 hours is $160. The lower salary can be the better job.
7. Ask what the listing says. A growing share of psychiatry listings now state compensation up front. If the employer hiring down the road is posting $340,000 for the work you do at $290,000, you have your answer and your negotiating position in one line.

If three or more of these point the same way, you are underpaid, and the fix is rarely a conversation with your current employer alone. It is an offer in hand. Medscape found 65% of psychiatrists feel fairly compensated, which is high for medicine — but 15% now expect their pay to fall this year, nearly double the share a year earlier, and 61% of physicians overall think physicians are underpaid.³⁴ Feeling fairly paid and being fairly paid are different questions, and only the second one has a number attached.

Psychiatrists are not the only mental-health prescribers whose pay is shifting. PMHNP salary in 2026 and psychiatric PA salary in 2026 cover the advanced-practice side of the same market, which increasingly sets the floor for what employers will pay for medication management.

Sources

1. 01
   BLS Occupational Outlook Handbook — Physicians and Surgeons (May 2025 wages, 2025–35 projections)www.bls.gov/ooh/healthcare/physicians-and-surgeons.h
2. 02
   BLS Occupational Employment and Wage Statistics — Psychiatrists, 29-1223 (May 2025)www.bls.gov/oes/current/oes291223.htm
3. 03
   Medscape Psychiatrist Compensation Report 2026www.medscape.com/p11/medscape-psychiatrist-compensat
4. 04
   Becker's Behavioral Health — Psychiatrist pay falls despite broader physician compensation growth (May 2026)www.beckersbehavioralhealth.com/finance/psychiatrist
5. 05
   Doximity — 2026 Physician Compensation Reportwww.doximity.com/reports/physician-compensation-repo
6. 06
   Doximity — 2025 Physician Compensation Reportwww.doximity.com/reports/physician-compensation-repo
7. 07
   AMN Healthcare — Psychiatrist Salary Guide 2025 (2025 Review of Physician and Advanced Practitioner Recruiting Incentives)www.amnhealthcare.com/blog/physician/perm/psychiatri
8. 08
   Marit Health — Psychiatrist salary benchmarks (August 2026)www.marithealth.com/o/-/psychiatrist/salary
9. 09
   SalaryDr — Psychiatry compensation (October 2026)www.salarydr.com/specialty/psychiatry
10. 10
    Locumstory (CHG Healthcare) — Locum tenens pay trends by specialty (September 2026)locumstory.com/spotlight/locum-tenens-compensation-t
11. 11
    Indeed — Psychiatrist salaries at Talkiatry (August 2026)www.indeed.com/cmp/Talkiatry/salaries/Psychiatrist
12. 12
    Ellis — California Department of Corrections and Rehabilitation wage filings, psychiatrists (2026)www.ellis.com/visa-sponsors/california-department-of
13. 13
    Department of Veterans Affairs — 2026 Physician, Dentist and Podiatrist annual pay tableswww.va.gov/OHRM/Pay/2026/PDOP/PayTables.pdf
14. 14
    HRSA — National Health Service Corps Loan Repayment Programnhsc.hrsa.gov/loan-repayment/nhsc-loan-repayment-pro
15. 15
    FastRVU — Psychiatry RVU guide, 2026 CMS values and conversion factor (January 2026)fastrvu.com/articles/psychiatry-rvu-guide
16. 16
    Journal of Accountancy — Social Security wage base and COLA announced for 2026www.journalofaccountancy.com/news/2025/oct/social-se
17. 17
    Becker's Payer — KFF 2025 Employer Health Benefits Survey: family coverage reaches $27K (October 2025)www.beckerspayer.com/research-analysis/employer-spon