Leaving academia for private practice

[whopper]

Just wanted to announce it on the forum since last academic year during interviews I did get some of the applicants asking me "are you Whopper from SDN?"

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[MacDonaldTriad]

Best of luck. I know a fair number of people who have taken your path. I can’t think of any that admit they regret the decision. Generally they are better compensated, but perhaps a little more narrowed in terms of tasks but that doesn’t have to be the case.

 

[sunlioness]

Best wishes!!


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[Ceke2002]

All the best

 

[TexasPhysician]

Smart move......from a biased perspective.

 

[smalltownpsych]

Good luck and I think they are going to lose a great teacher. I know I have learned at least a thing or two from you just on the forums. Good luck with the endeavor. Are you joining a group practice or going solo? Insurance panels or private pay? We need details.

 

[SXMMD]

Well, are you?

Cheers and good luck!

 

[Leo Aquarius]

Whopper, you've been an amazing mentor on this board for years. I remember when I first joined you were the voice I looked up to, and still do.

If you leave us I'm gonna cry.

 

[whopper]

I'm getting older and came to the realization that I would not be able to pay for my kids' tuitions if they were to get into one of those expensive elite schools if I stayed in academia. No I do not intend to push them in such a direction but I want to be able to keep the option open for them. My father came to the U.S. with nothing other than his health, his education, and some broken English and was able to attain an upper-middle class status and insisted he pay for my college despite that I told him I'd do it on my own.

I feel that for me not to continue something my dad did for me would be selfish and not living up to what I believe a parent with the means to do so should do for his own children.

I will say the place I am at does have it's merits. I'm not trying to say that because the cog that is me that didn't fit should be taken as a statement that the department is bad. There are some truly excellent psychiatrists there and for that reason my decision to leave did cause me a lot of internal emotional conflict.

While money is the main factor there were some problems I was having with the job but these were issues where it's not really fair to mention them on this forum.

Private practice pays a lot more and I was asked by literally the top practice in the city to join them. The open offer was temporary. If I didn't take it up I could've lost it. It is made up of all academic and former academic doctors with impressive credentials all doing good practice. My overhead to the practice is only my rent, my secretary's salary, the billing, and keeping up the computer server. The guy who heads the practice has it set up so that all the doctors there h own their own practices and we only share secretaries such as one covering the other if a secretary leaves the job for another or attendings covering the other during weekend call.

Many practices ask for 30-40% overhead but this one is only the expenses above that I am confident will lead to less than 20%.

Had I stayed in Cincinnati I likely wouldn't have left academia or would've taken up a job as the forensic director in the local state hospital that was the #2 position in the hospital and would've led to a path to be the #1 doc there years down the road. It was not my choice to move out of there. I did it to support my wife who got a professor's position in St. Louis. I still have a lot of respect for that department that is made up of docs like Paul Keck, Micheal Keys, Susan Mcelroy, and Doug Mossman, all ranked top 100 doctors in the country. Wow, 4 of them all in the same place.

If anything I figure leaving the university might have me on the board more cause the time I left for months was when I joined U of Cincinnati and my itch to teach was being scratched there. With no teaching exposure in private practice the itch will get worse.

 

[Ceke2002]

I'm getting older and came to the realization that I would not be able to pay for my kids' tuitions if they were to get into one of those expensive elite schools if I stayed in academia. No I do not intend to push them in such a direction but I want to be able to keep the option open for them. My father came to the U.S. with nothing other than his health, his education, and some broken English and was able to attain an upper-middle class status and insisted he pay for my college despite that I told him I'd do it on my own.

I feel that for me not to continue something my dad did for me would be selfish and not living up to what I believe a parent with the means to do so should do for his own children.

I will say the place I am at does have it's merits. I'm not trying to say that because the cog that is me that didn't fit should be taken as a statement that the department is bad. There are some truly excellent psychiatrists there and for that reason my decision to leave did cause me a lot of internal emotional conflict.

While money is the main factor there were some problems I was having with the job but these were issues where it's not really fair to mention them on this forum.

Private practice pays a lot more and I was asked by literally the top practice in the city to join them. The open offer was temporary. If I didn't take it up I could've lost it. It is made up of all academic and former academic doctors with impressive credentials all doing good practice. My overhead to the practice is only my rent, my secretary's salary, the billing, and keeping up the computer server. The guy who heads the practice has it set up so that all the doctors there h own their own practices and we only share secretaries such as one covering the other if a secretary leaves the job for another or attendings covering the other during weekend call.

Many practices ask for 30-40% overhead but this one is only the expenses above that I am confident will lead to less than 20%.

Had I stayed in Cincinnati I likely wouldn't have left academia or would've taken up a job as the forensic director in the local state hospital that was the #2 position in the hospital and would've led to a path to be the #1 doc there years down the road. It was not my choice to move out of there. I did it to support my wife who got a professor's position in St. Louis. I still have a lot of respect for that department that is made up of docs like Paul Keck, Micheal Keys, Susan Mcelroy, and Doug Mossman, all ranked top 100 doctors in the country. Wow, 4 of them all in the same place.

If anything I figure leaving the university might have me on the board more cause the time I left for months was when I joined U of Cincinnati and my itch to teach was being scratched there. With no teaching exposure in private practice the itch will get worse.

You, Sir, are a class act.

 

[Bartelby]

I have heard of other good academic psychiatrists leaving for the same reason (money), especially in higher cost of living areas. It's too bad, thinking that programs are losing teachers like Whopper. I've wondered how academic centers would be different if the pay matched private practice numbers, although I'm aware that achieving that probably just isn't realistic.

That said, I think of myself as a decent teacher and I think I will most likely end up in the private practice world as well, largely because of money and the ability to have more choice in treatment approaches (as in I can take on therapy cases or increase visit length/frequency where I feel it is needed).

 

[whopper]

When I left U of Cincinnati to SLU my pay dropped significantly. State universities like U of C are state-subsidized and that department was financially healthy. It offers a great pension and free healthcare for the rest of your life if you stayed for 25 years plus if you previously worked for the state or federal government the time put in there was added to the 25 years needed.. I also had side forensic cases that paid over $400/hour, much more in some cases that was done through the university. I was also on a track to become someone big in the department had I stayed there.

Money was not a problem there.

When I joined SLU my pay dropped significantly. SLU is a small private university that is not state subsidized so no nice pension, no free healthcare the rest of my life after I leave the job, and no forensic side cases making money. I did a private case through SLU and they raked in 100% of it (I was in shock, I didn't know until I noticed my check had no extra money). That case was done outside my full-time job responsibilities. Again I was in utter shock. It definitely was something I brought up with the department.

SLU has gone through a major transition in the last few years. It used to have a child fellowship and all the attendings from there left to join Washington U and started the child fellowship there. It's had a lot of attending turnover and it used to be a combined neuro and psychiatry department and just split a few weeks ago. The department lost most of it's attendings a few years ago and has been rebuilt from almost nothing.

I do have faith in the department because 3 of the attendings there are some of the top guys in the field: Henry Nasrallah (a top researcher in schizophrenia), George Grossberg (geriatric psychiatry) and Alan Felthous (a Guttmacher award winner and head editor of several forensic psych journals). A new doctor there is likely going to be a major forensic psychiatrist in the next 5-10 years and is already an AAPL officer. It's still undergoing revisions.

I

 

[F0nzie]

IMO pay is weak across the board unless you do a mix. For example, get an inpatient job and cram your 15 patients in the morning. Bam there is your 200k. Now go to an outpatient practice and cram 3-4 patients an hour until 5 or 6pm. Another 150-200k. Then cover 1 day on the weekend if you really want to be in the fast lane. Another 50k+. Voila now you're in the 400k+ range playing with the big boys.

 

[sunlioness]

And no time or energy to spend it!!


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[Chimed]

Best of luck, whooper!!! I completely understand where you're coming from. I'm having to make similar decision right now. I'm currently in academics and moving for family reasons. I've interviewed at a major academic center and some private organizations. The difference in pay is something substantial, to say the least. I did not go into psychiatry, or medicine for that matter, for the money. But, wow, when I start looking at my 6 figure student loans, needing to start planning for retirement (I'm getting a late start), and things like education for kids, it really starts to hit how much that costs. I'm also looking to move into a city that has a relatively high cost of living. I'm still waiting to see offers, but as much as I love being in academics, I'm starting to lean toward a private organization.

 

[Doctor Bagel]

IMO pay is weak across the board unless you do a mix. For example, get an inpatient job and cram your 15 patients in the morning. Bam there is your 200k. Now go to an outpatient practice and cram 3-4 patients an hour until 5 or 6pm. Another 150-200k. Then cover 1 day on the weekend if you really want to be in the fast lane. Another 50k+. Voila now you're in the 400k+ range playing with the big boys.

So here's a question -- can anyone actually deliver good care and be satisfied with their work with a schedule like this?

 

[shan564]

Oh, you're working at (that nice group practice in that nice part of town) with (that well-known doctor who used to be at WashU)? That's awesome, I think everybody there seems to be happy with their job. I was just there last week - he was giving a talk to residents about the logistics of private practice.

 

[OldPsychDoc]

So here's a question -- can anyone actually deliver good care and be satisfied with their work with a schedule like this?

No--but that's not why they do that. It's about trading the satisfaction for cash.
Plenty of job and life satisfaction available in the quarter-million a year range...

 

[Chimed]

I have heard of other good academic psychiatrists leaving for the same reason (money), especially in higher cost of living areas. It's too bad, thinking that programs are losing teachers like Whopper. I've wondered how academic centers would be different if the pay matched private practice numbers, although I'm aware that achieving that probably just isn't realistic.

That said, I think of myself as a decent teacher and I think I will most likely end up in the private practice world as well, largely because of money and the ability to have more choice in treatment approaches (as in I can take on therapy cases or increase visit length/frequency where I feel it is needed).

That's true. For example, the pay difference where I'm looking between academics and private organizations is something on the order of 50K. And the private places still offer health care and retirement packages. And that's in a high cost of living city.

 

[Chimed]

No--but that's not why they do that. It's about trading the satisfaction for cash.
Plenty of job and life satisfaction available in the quarter-million a year range...

I suppose that's a matter of personal preference. There's but there a point where I don't care how much I'm offered, I couldn't be happy working in conditions like that even for 500K. I'll take the 200K and give good patient care any day. Sorry to sound all high and mighty but if that's why someone goes into medicine, they could have picked easier ways to get that kinda of salary.

 

[TXpsydoc]

my plan is do something less intense like inpatient in a residency program with residents helping and 11-12 long term patients (los 38 days - CRU unit); and do forensic cases while on the clock.

before I was doing locum tenems at a state school for IDD and I saw 8 patients once a week (mostly non-verbal). I probably averaged less than 12 pt encounters a week. I could have churned out 2-3 basic competency evals a week in that job while on the clock. (pay was higher than academia).

whooper, my academic program takes a 50% cut on forensic cases (or any outside work). i fully intend to do it during my work hours. i have been taking this up with them and atleast got them to lower the high hourly rate (don't think a fresh grad yet to be board certified in forensics can expect top dollar).

they took 6% from the evaluation where I did my forensic fellowship. however 50% is still high even after considering they took 100% from you; especially since I am getting the evals on my own without the help of the program.

 

[flight24]

I'm getting older and came to the realization that I would not be able to pay for my kids' tuitions if they were to get into one of those expensive elite schools if I stayed in academia. No I do not intend to push them in such a direction but I want to be able to keep the option open for them. My father came to the U.S. with nothing other than his health, his education, and some broken English and was able to attain an upper-middle class status and insisted he pay for my college despite that I told him I'd do it on my own.

I feel that for me not to continue something my dad did for me would be selfish and not living up to what I believe a parent with the means to do so should do for his own children...

As someone from a very similar background, this is completely understandable and I intend to do the same as well.

 

[notdeadyet]

they took 6% from the evaluation where I did my forensic fellowship. however 50% is still high even after considering they took 100% from you; especially since I am getting the evals on my own without the help of the program.

Wow, that seems high. I'm looking at about 20% cut, and in return, they handle billing and collections and I have access to conference room/interview room and can interview during the work day, assuming I can still handle my main duties.

 

[Shikima]

Wow, that seems high. I'm looking at about 20% cut, and in return, they handle billing and collections and I have access to conference room/interview room and can interview during the work day, assuming I can still handle my main duties.

I have a similar deal. It's not bad tbh. Covers all OH that I have for my clinic, including secretarial and nursing support.

 

[masterofmonkeys]

Some academic places offer some really competitive compensation. I consider 10-20% less than median 'competitive' especially if residents are handling much if not most of the documentation. Others...don't. Which generally comes down to an acquisitive Dean's office and an abnormally large administration.

Also, don't forget that state or not, any place that receives GME payments through CMS is making out like a bandit in subsidies that they then pretend don't exist when it comes time to talk budget with the actual docs.

 

[downwithDTB]

Also, don't forget that state or not, any place that receives GME payments through CMS is making out like a bandit in subsidies that they then pretend don't exist when it comes time to talk budget with the actual docs.

But it's SO expensive to train residents.

 

[whopper]

Oh, you're working at (that nice group practice in that nice part of town) with (that well-known doctor who used to be at WashU)? That's awesome

Yep.

That's why I couldn't turn it down. I was willing to work at SLU longer cause I knew me leaving was going to leave a major dent in their works. Nasrallah, the head of the psych department is a good guy and I wanted to leave in the last painful manner possible for that department. My offer at the new practice, however, wasn't going to be open forever and it's considered the "prestigious" practice in town, the best one by patients and other attendings.

Now that I'm leaving I am actually feeling very relieved and looking forward to the new practice. I'm going to miss inpatient because that's always been my strongest area and favorite area of practice but all of my prior outpatients told me I did a great job with them and I had top marks from previous places I worked at. I am going to try to partner up with someone so I could perhaps not do outpatient all the time and sneak in some inpatient here and there.

That "well known" doctor is a class-act. Rated one of the best in the city and previous national awards. He also goes back to his home country once a year and does free healthcare for them while he's there.

I just didn't want to join any practice. I already was approached by 2 private practices and these had shady reps. I only would've left SLU this quickly if I could get in the best one in this area.

 

[whopper]

Wow, that seems high. I'm looking at about 20% cut, and in return, they handle billing and collections and I have access to conference room/interview room and can interview during the work day, assuming I can still handle my main duties.

While I was at U of Cincinnati they took 30%.

For those of you that think it's high I'd disagree. Heck I would've still done it happily if they took off even more. Here's why.
I mentioned that forensic psychiatry is highly connection-driven. U of C had all of the good connections in the city arguably the bottom half of the state of Ohio and Northern KY and did national cases. Some of their docs were go-to-guys for entities such as the FBI.

As a guy that was fresh out of fellowship to be invited into the circle that they rarely invited people into was an honor.

Aside from this the guys running the program went through everything I did tp help prep me. A lot of fellows graduate never having done the big cases such as a a multi-million dollar lawsuit, execution, murder, or rape case. These cases are kind of like surgery. After you assist on a few of them then you do them on your own, or so you would want it to be that way. Being part of that organization it was like I could be the assist guy and bolster up my own experience and then slide into the big stuff a pro instead of doing the big stuff not really knowing what I was doing the first few times (and unfortunately a lot of docs do that).

Being there I had an entry, had I wanted, to become a national figure in the field.

U of C also protected their own. A buddy of mine that was also a fellowship graduate and favored by the department was sued in a manner in which if he did the case privately his malpractice wouldn't have covered it. Why? He wasn't sued for malpractice, he was sued for a civil rights violation. The malpractice carrier would've turned down covering him. U of C covered him despite that the legal costs were into the 6 figures.

I said this many times. I got a lot of faith in the fellowship over in Cincinnati. The same guys are running it so I'm sure it's still solid.

 

[Leo Aquarius]

While I was at U of Cincinnati they took 30%.

For those of you that think it's high I'd disagree. Heck I would've still done it happily if they took off even more. Here's why.
I mentioned that forensic psychiatry is highly connection-driven. U of C had all of the good connections in the city arguably the bottom half of the state of Ohio and Northern KY and did national cases. Some of their docs were go-to-guys for entities such as the FBI.

As a guy that was fresh out of fellowship to be invited into the circle that they rarely invited people into was an honor.

Aside from this the guys running the program went through everything I did tp help prep me. A lot of fellows graduate never having done the big cases such as a a multi-million dollar lawsuit, execution, murder, or rape case. These cases are kind of like surgery. After you assist on a few of them then you do them on your own, or so you would want it to be that way. Being part of that organization it was like I could be the assist guy and bolster up my own experience and then slide into the big stuff a pro instead of doing the big stuff not really knowing what I was doing the first few times (and unfortunately a lot of docs do that).

U of C also protected their own. A buddy of mine that was also a fellowship graduate and favored by the department was sued in a manner in which if he did the case privately his malpractice wouldn't have covered it. Why? He wasn't sued for malpractice, he was sued for a civil rights violation. The malpractice carrier would've turned down covering him. U of C covered him despite that the legal costs were into the 6 figures.

I said this many times. I got a lot of faith in the fellowship over in Cincinnati. The same guys are running it so I'm sure it's still solid.

I saw Goodfellas not too long ago, and this reminded me of that movie. They didn't ask any "special" favors of you right?

 

[whopper]

No. Another nice thing was I never knew any of the guys there to fudge on ethics. I was never asked to do so and even had a major case where the truthful opinion wasn't the profitable one but we stuck to our guns.

What happens politically with these types of things is like the lawyer being a casting director in a movie.
Lawyer wants the best and he knows his client is innocent. He goes to the honest guy in the university. This is the Deniro expert witness. (Bad pun cause Deniro was one of the mafia guys in Goodfellas but you get the idea).
Lawyer is stuck with a no-win case and needs an expert witness that'll say anything for the money. You go with the seedy C-list actor expert witness.

U of C was the Deniro. Why is it so connection driven? Its cause when a lawyer knows what a guy is like he sticks with that guy unless he needs a different type of guy for the job. After he knows a few guys he knows which doc to be needed for what. Like I said it's being a casting director.

Unfortunately I do know of an Ivy League guy that was willing to say anything. I wish I was able to audio record his statements he made to me about how he knew he'd win the case because of the color of his suit and not based on the real facts of what happened.
Skip to one minute.

 

[mgdsh]

U of C had all of the good connections in the city arguably the bottom half of the state of Ohio and Northern KY and did national cases. Some of their docs were go-to-guys for entities such as the FBI.

Those 'Nati streets.

 

[TXpsydoc]

I was looking for data on the profitability and feasibility of a forensic evaluation service for an academic psychiatry department. I am the sole forensic psychiatrist in my department. My dept. wants to hire a forensic psychologist to do competency evaluations on my patients (currently we contract it out).