Academic Appointment + Private Practice

[CutterSpindell]

Hi all,

I am going to be a MS1 in the fall and am very interested in psychiatry. I understand that it's more than a little early for me to be considering practice settings, but I am curious none the less.

The notion of running a solo private practice is very appealing to me and I believe I have the entrepreneurial nature to be successful in this setting. I believe that if I was going to open a private practice I would want to do it alone so that managing it would be on my own terms. That being said I have heard that this can be a very isolating experience. My question is how easy is it to obtain a part-time academic appointment while also running a solo private practice to experience the "best" of both worlds. Any and all feedback is appreciated!

Thank you!

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[hamstergang]

I know plenty of attendings that are doing precisely this. Some are working full-time in the academic setting and then do some additional hours in their PP. It's more work, but they make plenty of money for it.

 

[nitemagi]

I do the other model. I have my private practice, with an academic appointment for teaching at the university. I supervise medical students and residents, including psychotherapy for residents. It's not paid, though. So you're trading a couple hours a week for an academic title, really.

 

[CutterSpindell]

I do the other model. I have my private practice, with an academic appointment for teaching at the university. I supervise medical students and residents, including psychotherapy for residents. It's not paid, though. So you're trading a couple hours a week for an academic title, really.

nitenagi would mind sharing with me what your experience in your solo private practice has been? Are you happy in this practice setting? Do you accept insurance? Did you hire billing staff or therapists work with you? I'm just very curious about this setting.

 

[nitemagi]

There are many different models. In much of the country, people accept insurance, get billers, etc.

I do probably 60+% psychotherapy, then rest medications. I also do several kinds of the therapy, including hypnosis. Since I fill a unique niche I take cash only.

I don't find it particularly lonely, since I have a full regular life including my marriage and friends.

 

[CutterSpindell]

There are many different models. In much of the country, people accept insurance, get billers, etc.

I do probably 60+% psychotherapy, then rest medications. I also do several kinds of the therapy, including hypnosis. Since I fill a unique niche I take cash only.

I don't find it particularly lonely, since I have a full regular life including my marriage and friends.

Thanks for the response!

 

[CutterSpindell]

Can anyone else share their experiences in solo private practice? My initial feeling is that I would like to accept insurance to treat a wide spectrum of patients. With a medical biller can this be done with relative ease or does this tend to create more headaches than it's worth?

 

[CutterSpindell]

Can anyone else share their experiences in solo private practice? My initial feeling is that I would like to accept insurance to treat a wide spectrum of patients. With a medical biller can this be done with relative ease or does this tend to create more headaches than it's worth?

Any thoughts?

 

[vistaril]

Can anyone else share their experiences in solo private practice? My initial feeling is that I would like to accept insurance to treat a wide spectrum of patients. With a medical biller can this be done with relative ease or does this tend to create more headaches than it's worth?

Sure it can be done- in fact still greater than half do. Including some that take even Medicare/aid. But what you need to understand is that psychiatry practices generate a small amt of total revenue, so if you bring in a person to do this that is taking even more money out of a fairly small pot.

The easiest way in psych to make good money is to just work various jobs as a hired gun/ind contractor when needed. But you are never going to build a great rep or good cv doing this. If that sort of stuff matters to you...

 

[CutterSpindell]

Sure it can be done- in fact still greater than half do. Including some that take even Medicare/aid. But what you need to understand is that psychiatry practices generate a small amt of total revenue, so if you bring in a person to do this that is taking even more money out of a fairly small pot.

The easiest way in psych to make good money is to just work various jobs as a hired gun/ind contractor when needed. But you are never going to build a great rep or good cv doing this. If that sort of stuff matters to you...

Thanks for the response vistaril! Can you give me some rough numbers on what a full practice that accepts insurance can except to make per year after overhead (medical biller, malpractice, rent, etc)?

 

[F0nzie]

https://www.aacap.org/App_Themes/AA...tarting_a_private_practice_webinar_part_2.ppt.

Comes in a 3 part power point. Part 2 is most relevant to your question.

 

[CutterSpindell]

https://www.aacap.org/App_Themes/AA...tarting_a_private_practice_webinar_part_2.ppt.

Comes in a 3 part power point. Part 2 is most relevant to your question.

Great resource! Much appreciated F0nzie! Do you if the $174,000 income is before or after operating expenses for an insurance based practice?

Can anyone comment of the ethics of a cash based practice? Seems ideal to not accept insurance, but in a field with such a shortage of practitioners I think I would feel somewhat obligated to accept insurance. Comments?

 

[F0nzie]

Great resource! Much appreciated F0nzie! Do you if the $174,000 income is before or after operating expenses for an insurance based practice?

Can anyone comment of the ethics of a cash based practice? Seems ideal to not accept insurance, but in a field with such a shortage of practitioners I think I would feel somewhat obligated to accept insurance. Comments?

Private practice is a wild card. Asking how much pp makes is like asking what numbers I will get when I throw dice. Some days I make a good amount and other days I make 1/4th of that. Your intakes will cancel, your patients will get sick, they will forget their appointment, or they will need to reschedule. The only way to consistently cross a set money threshold is to cram as many patients as you can in 1 day. It is up to you how you want to work that out.

What are the ethics of accepting insurance but not medicare and medicaid? What are the ethics of getting paneled on 1 insurance company and not 10 insurances? No different than the ethics of cash IMO. Do you what you think is right...nobody is stopping you from offering free psychiatric care to a patient that calls you and has no money.

 

[F0nzie]

FYI we offer plenty of free care for patients in our private practice. We just don't advertise ourselves as a free clinic. Once you pay your overhead, your loans, and bills, you can give as much as you want.

 

[whopper]

When I did private practice, I did occasionally allow a few patients to be seen for free or at reduced fee because I believed they were trying to do their best and their cases were more complicated. You got to be careful about this. In giving a reduced cost service, you could develop counter-transference, especially if the patient exhibits some very cluster B and other pet-peeve behaviors. It could make you regret you offered them such a service and could make you do something out of emotion.

 

[F0nzie]

Also you would be surprised how much uncompensated time you offer in a private practice unless you nickel and dime your patients for forms, letters, emails, phone calls, therapists, docs, or times when family starts calling you. You can limit a lot of that with solid boundaries but you cannot always avoid it. It's a different experience than walking into a unit, rounding on patients, then leaving for the day.

 

[CutterSpindell]

Thank you all for the feedback! I certainly didn't mean to imply that cash only practices are unethical. I am admittedly naive to this business and appreciate all of your insights.

Can anyone comment on what they have found to be the ideal private practice model and why? Solo vs group. Cash vs insurance. etc ...

 

[CutterSpindell]

Thank you all for the feedback! I certainly didn't mean to imply that cash only practices are unethical. I am admittedly naive to this business and appreciate all of your insights.

Can anyone comment on what they have found to be the ideal private practice model and why? Solo vs group. Cash vs insurance. etc ...

Any thoughts?

 

[dl2dp2]

Your question has an answer that is extremely location and context dependent. Fonzie's PPT is legit for a typical average community in the US, but for certain markets, the numbers are way off. If you are the right kind of psychiatrist you can potentially make a LOT more in certain markets.