Can you join cash-only practices?

[SoulinNeed]

One of the things that intrigue me about Psychiatry is the ability to do therapy services verus just med management. A lot of people say that you can have more time in a cash only setting vs. just traditional insurance. I'm a bit confused about cash only, though. Can you join a cash only practice, like any other physician group, or do you have to start your own practice? And if it's both, how available is the former? I think I would be more interested in joining an established practice that's cash only versus having to start my own. Thanks for any help.

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[dl2dp2]

you can join a group practice, but you'll just get paid from whatever revenue you generate, minus your share of the administrative overhead. given the low overhead, especially in a cash practice, people don't usually find it very advantageous. hence the prevalence of solo in psychiatry.

group practices are more useful when cash practice isn't feasible (i.e. smaller markets). the expensive overhead are things like insurance credentialing, hiring a biller, etc.

 

[F0nzie]

The volume and number of referrals for cash practices are less than insurance based ones. The challenge would be to fill your caseload and get pts to buy in to see you instead. Also the quality of your work would have an impact on the reputation of the practice and referral sources.

 

[masterofmonkeys]

Recent graduate just did. Requires a certain climate and/or need. There are places in the country where people prefer cash only docs (of all kinds) as its assumed higher quality. They aren't necessarily rich, they just figure it's a good signal. A lot of times the setup is 'we expect you to see x number of patients/week for y salary. You keep everything above that'. It's a way of not having to turn away people and keeping your referral base solid. For cash only docs 'not accepting new patients' temporarily can quickly turn permanent.

 

[TexasPhysician]

Sure. There are group practices of cash-only psychiatrists. I'm part of one.

 

[Thewonderer]

I think you can join a group cash-only practice. It is just rare. It is hard for a cash-only private practice to fill doctors up with the number of patients, considering the limited number of referrals they get as it is.

And let us say, you are the rain maker, and the patients are referred to you specifically, it is then hard to tell them, "well, please see my associate. I charge $350 per hour but my associate only charges $250 per hour, and he/she is just as good as me." The first question the patients will ask is, "then why is he/she only charging $350 and you charge $250." Don't forget. The patients are referred to you only and are willing to open their wallets. They get suspicious that your associates are just not as good and they will hesitate.

Then once you raise the associates' rates to your rates and they are now doing well, then they want to leave and open up their own practice.

There is a reason why most if not all cash-only practices are still solo practitioner based.

In my area, I have seen many cash-only practices bringing in younger associates or even nurse practitioners at lower rates. I think the longest these people stay are two years at most. And they are off on their own, and the "group" basically got broken up, back to square one, i.e. solo practice again.