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Is psychiatry a field that is conducive to setting up an 8-5 type private practice? Is this a specialty where that goal is still attainable?
Is psychiatry a field that is conducive to setting up an 8-5 type private practice? Is this a specialty where that goal is still attainable?
Yes and yes.
Definitely doable. I'm in the middle of starting my own solo practice myself. It's a lot of work, but I'm having fun with it. After residency, I worked for a group practice where I just wasn't happy and while it's nerve wracking being on my own for so many reasons, it's also so nice being my own boss and setting my own schedule. I never anticipated all the little things though. Little things that cost money and add up. Like trash cans. Never in my life had to worry about whether my office had a trashcan in it and now I am going to office stores pricing trashcans.
This is where a Costco and an Amazon Prime membership become key
Wouldnt overhead be a LOT less than a PCP office? No EKG machines etc. Just a chair, desk, trash cans, etc. and a billing service and possibly a secretary. I would say in a cash only private practice, you could easily make 200k after expenses. Am I logical in my thought process?
Oh yes, it's definitely a lot less. But I'm still being surprised all the time -especially by the cost of paying for my own health insurance. I'm not cash only because it takes too long to build a sustainable practice that way when most everyone has insurance that they understandably want you to take. The credentialing process has also been enlightening. But I anticipate that after this lean period I'll be able to make a nice living for myself.
And yeah, I definitely need to look into Cost Co.
setting it up is exceedingly easy...getting patients and maintaining a practice that is viable where you are getting paid is the hard part...
I hear that generally there is a shortage of psychiatrists in most areas. I assumed getting patients was not difficult?
I would guess this is location-dependent. I imagine it would be more competitive in a big city, but how will that affect income? Say I wanted to set up a PP in washington DC, how would that compare (income/traffic-wise) to a PP in a rural town with little/no psychiatrists?
re: getting on insurance panels... is the process any easier/faster if you're already paneled as a hospital employee? (not as a resident, as an attending...)
re: getting on insurance panels... is the process any easier/faster if you're already paneled as a hospital employee? (not as a resident, as an attending...)
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It was easy for me to stay credentialed on BC/BS when I switched from a CMHC to private practice (therapist, not psychiatrist), but getting the billing right was a nightmare for a while.for some insurance panels, it is easier. It was very easy for me when I left the local university to stay on the BC/BS panels.
The medicare and medicaid transfer paperwork was complicated.
That sounds like a slice of heaven. Not to mention health benefits, paid liability insurance and a prescribed sum of money being put directly into my account at regular intervals. Private practice is for the birds. (At least right now it is).
The best resources are people in the community where you are.
Having moved around initially within the state, I found that every community is a little different and sometimes a lot different.
So it is better to ask the physicians around you. This includes psychiatrists as well primary care doctors. It is also a good idea to get in touch with some of the social workers and psychologists because they're often having trouble finding a psychiatrist.
I am actually looking to get out of solo private practice. I think working with a group would be fine if you're sharing costs and can afford some administrative support, but doing it all by myself has proven way too isolating and frustrating.
Good question, I wonder if the patient loads would be the same or different depending on rural vs city. One thing I dont get is if a place is rural, do you get higher reimbursement?
What were the main factors in making you leave private practice? I hear the first year is hard, were you in it longer than that?
Just over a year. The only thing I liked about solo practice was being able to set my own schedule. Other than that, it was for the birds. I think someday I might enjoy a private practice with a group of at least a few other physicians, but solo was just way too isolating and I don't like running my own business or being on call 24/7. I did pretty darned well money-wise for only being at it a relatively short while and for having my first biller turn out to be utterly incompetent, but I pretty much disliked every minute of it and therefore was never motivated to work the extra bit you need to in order to make the good money. I'd rather work for someone else, have my health benefits, have my paycheck automatically deposited at regular intervals, be around other docs, have someone else pay for my administrative help, and be able to do some clinical teaching (which I really love and really missed). I'm grateful to have the opportunity to get back into academic medicine.
Bottom line, solo private practice just fundamentally was not a mesh with my personality. I'm probably not the best person to talk with in regards to what little things are difficult for people who overall like this environment. I just didn't like the whole package.
Just over a year. The only thing I liked about solo practice was being able to set my own schedule. Other than that, it was for the birds. I think someday I might enjoy a private practice with a group of at least a few other physicians, but solo was just way too isolating and I don't like running my own business or being on call 24/7. I did pretty darned well money-wise for only being at it a relatively short while and for having my first biller turn out to be utterly incompetent, but I pretty much disliked every minute of it and therefore was never motivated to work the extra bit you need to in order to make the good money. I'd rather work for someone else, have my health benefits, have my paycheck automatically deposited at regular intervals, be around other docs, have someone else pay for my administrative help, and be able to do some clinical teaching (which I really love and really missed). I'm grateful to have the opportunity to get back into academic medicine.
Bottom line, solo private practice just fundamentally was not a mesh with my personality. I'm probably not the best person to talk with in regards to what little things are difficult for people who overall like this environment. I just didn't like the whole package.
I've been doing the private practice thing for 4 months now. Things have picked up and now I'm making good money at it. I think I got the gist of it but I'm still contemplating leaving.
A guy with a private practice he owns wants me to take over his practice. It's in the heart of a metropolitan area and he gets referrals out the wazoo because of it's location. The place I'm at now, it's not my own practice. They take a cut of what I earn, though I don't have to worry about the usual office bullspit like making sure the sidewalks are shoveled.
I'm still trying to figure all of this out. I got 5 job offers, each of them very good and paying very well. I can't do all of them. Taking one nixes the others.
That is one of the main reasons I will not likely go into private practice. Being in child, I'll admit the amount I could make in private practice is appealing, especially when I look at my student loans eek. But I love the team approach to patient care and would miss the team meetings, the debates on the best patient care, working with medical students and residents, and being able to walk down to my colleagues office and shoot the breeze. It would be too isolating for my taste. The pay will be lower, but I'm going into academics for a lot of those reasons. But academics has its own draw backs...
That doesn't really fly. There are urgent issues that come up that don't necessarily merit an ED visit. Crisis services that are affiliated with hospital systems are a bit better (and my voicemail made reference to both the ED and a crisis line), but still sometimes a patient does really need to speak to a physician urgently outside of normal business hours. I had colleagues who were also in solo practice and we would cover each other for vacations and such, but mostly it was just me on call 24/7. Most days people didn't call and calls in the middle of the night were exceedingly rare, but always knowing they could (and having several of these calls actually not constitute true urgent issues, but rather just people being impatient) and feeling physically tied to my cell phone wasn't pleasant for me.
I was also under the impression that many solo psychiatrists either have patients go to an ER or wait for normal business hours. I imagine that the on-call feature of a practice could easily be taken advantage of. Maybe I am wrong, but were you just being too nice and accommodating? I thought most psychiatrists don't offer 24/7 call. I also wonder if this is as much an issue with child psych.
Many do, but I think they're taking a risk. The ED oftentimes just isn't what's indicated. What came up most commonly was disorganized folks who didn't realize they were out of their meds. Normally, it might be okay to wait until business hours, but say you're a fairly brittle bipolar or physically dependent on benzos or something like that and it's a Friday night. They don't need to go to the ED right then, but they do need their meds before Monday or they might very well end up needing the ED. Yes, patients should keep better track of their prescriptions and request refills before 6pm on a Friday evening when they only have one pill left and most of them do. But you're still liable if you're unavailable (or haven't arranged for appropriate coverage) to the ones who don't and something bad happens to them.
There are a lot of negatives about private practice and there are a lot of positives. Same thing with HMO/Academic medicine.
Time:
Government is probably best followed by HMO/Academic. Private practice takes time, especially in the front end. Eventually though I prefer my practice where I take 8 weeks of vacation per year but work very hard when I am not on vacation.
Money:
Initially you are going to make most in an HMO setting followed by academic and then private practice unless you are in a group where they subsidize you. Eventually the private practice can pay off with substantially more money.
Flexibility/Control:
Debateable. You have a lot of control over schedule in private practice but at the same time, because you probably will work very hard initially, it becomes a moot point. You will have control over who you work with and don't have to deal incompetence as opposed to, in other settings have a situation where people cannot be fired. Having a better staff goes a long way and helps you be more productive and ultimately relieves a lot of your stress. At the end of the day you are rewarded and responsible for you own work.
Collegiality:
Also debateable, academic centers are very competetive, there is a lot of dumping, the researchers don't really want to do clinical work and no one is really happy with their salary. Other than working with residents and fellows and constant education there is very little I liked about it. Government settings and HMOs are the worst of both worlds, often populated by lazy people. In private practice I found that everyone is hard working and motivated. This lends to greater collegiality but you have to be careful to screen for people that only have their own bottom line in mind, even if it is at the expense of the group.
Ease of initiation:
Obviously this is where the rubber hits the road for private practice.
There is a lot of time, money and common sense investment to private practice. You have to be good at what you do and be a 'people person' in the real sense of the word. You also have to have a little bit of business sense or learn some. Insurance, billing, malpractice, referrals, accounting, staffing, call, furnishing, EMR and your location are just some of the things you have to think about before you ever see your first patient.
Government settings and HMOs are the worst of both worlds, often populated by lazy people.