A Coruña psychiatrist: €100 per patient, 15 daily

€100 per patient, 15 a day: how private psychiatry bills

A psychiatrist with her own practice in A Coruña seeing 15 patients a day at €100 each generates €1,500 per working day. No operating room, no significant medical supplies, and the rent of an apartment as the only apparent fixed expense. The case is presented by someone who claims to know her closely: appointments are closed until late January, there is reluctance to show the card terminal, and no invoices are issued. The fee itself does not scandalize anyone. What is disorienting is the volume.

How much does a full-time psychiatry practice bill?

Fifteen patients a day at one hundred euros amounts to fifteen hundred euros a day. Eleven hours of consultation provide ample margin to fit that number without rushing, and the source insists the schedule is full well into winter. The first objection raised is not about figures, but method: one hundred euros per session is a normal rate for private practice, but usually for one-hour sessions. If consultations last half the time, the price per minute doubles, and the patient pays for rotation, not therapy.

This is where the uncomfortable part begins. A specialist attending to fifteen people a day does not see them once: most return monthly or quarterly. This implies a portfolio of thousands of active records, and behind that portfolio lies years of work, a referral network, and a fruta built consultation by consultation. The business is not set up with a sign on the door.

The breakdown that halves the profit

The gross numbers are not the profit. On estimated annual billing of €170,000, the circulating calculation deducts between €15,000 and €20,000 for renting an apartment in a roughly central area, another €25,000 to €30,000 for a receptionist to open the door, and between €8,000 and €10,000 for electricity, water, heating, cleaning, and self-employment tax contributions (autónomos). That leaves around €110,000 gross, which nets out to between €70,000 and €80,000. The complete itemized breakdown is what deflates the fantasy: neither swimming in money nor living in misery.

The repeated conclusion is that the final margin hovers around half of the cash intake, but that half looks nothing like an employee's salary, because there are no employer contributions or unemployment benefits to cushion a bad year. When the patient stops coming, the rent bill still arrives just the same.

How much does a psychologist or psychiatrist with their own practice earn?

One case does not make a sector. The most reasonable criticism of the initial account is bias: it looks at professionals with the highest demand, not the average. Still, there are references pointing high: private-practice psychiatrists earning around €10,000 a month and psychologists with their own practices moving between €5,000 and €7,000 a month. It is not the standard, but it is not a unicorn either.

The business also has a peculiarity compared to other specialties. An oncologist or hematologist has little private practice to set up. Psychiatry, however, thrives on sustained demand and the practical impossibility of resolving issues through public healthcare, where waiting lists act as the best competitor’s sales pitch.

Private insurance pays for most consultations

The direct-payment model has been diluted. The estimate discussed is that 80% of private-practice patients come with insurance. Twenty years ago, those going to the private sector paid out of pocket, often €150 per visit; today that is the exception, not the norm.

Insurance premiums, between €50 and €100 a month, have made insurers the real payers for much of the sector. Hence some practices do not accept insured patients at all and ask at reception if the patient is paying cash or using a policy: the latter get paid later and less reliably. The suspicion that some professionals look down on public healthcare is partly explained by this math.

Private prescriptions are still paper, complicating everything

Here the fiscal side appears. Nine out of ten private prescriptions reaching pharmacies are on paper, although electronic private prescriptions with QR codes already exist. Cross-referencing these slips with declared income would require authorities to check data from pharmacies across Spain, not just in the city where the practice is located. Those defending that the system has the tools to do so recall that inspections already match dry-cleaning receipts with restaurant cash registers. Those arguing otherwise point to scale: too much dispersed data for questionable fiscal returns.

Added to this is the backdoor many denounce: specialists with private practices who also work in public hospitals and issue prescriptions from there, or patients who take signed paper to their primary care doctor to transcribe it into the public system without questions.

From fees to prescriptions: two crossing criticisms

The second line of attack is not price, but product. It is argued that private practice acts as a fast track to benzodiazepines and antidepressants, with successive medication changes until finding the dose that calms, leading to years-long addictions to tranquilizers. This accusation circulates without supporting data beyond personal experience, and others counter that the problem lies not in the payment counter but in a public system lacking trinc-up capacity.

The day’s curiosity comes from another profile in the comparison: an acupuncture professional with qualifications allegedly obtained in China, charging €60 for a one-hour session, treating three patients simultaneously in separate rooms, refusing cards, and maintaining a waiting list. The same pattern with fewer enabling credentials and lower fixed costs.

With these numbers on the table, the logical question is not how much a private psychiatrist earns. It is why, if the margin is so attractive, this business remains the domain of a few rather than a saturated sector.