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I am not advocating a 'bottom line' approach to practice, and not just because that approach has proven to come with some significant threats to long-term viability. I am just trying to balance the, "I want to help people!!" haze that tends to pervade private practice work and lead people to make wholy bad decisions about how to run their practice. We are highly educated professionals who provide a value service to our patients, but we often treat ourselves like 2nd class professionals. Plumbers, lawyers, accountants, and the like all provide valuable service to their customers, but because we are in a helping profession we are treated differently. We allow ourselves to be treated differently. I swear I am not a heartless guy, if I were I would have opened up a Cash-For-Gold/Cash Advance storefront and called it a day. Those things are goldmines, if you can look past the predatory practices. I am not advocating that approach. I am just trying to remind people that private practice is a business.
Absolutely,and I think a lot of people run successful practices as a business. Of course, rational business decision-making is partly to blame for our field's financial predicament though. I don't blame people for getting ahead where they can, because it is perfectly legal and why not?
But, now we have further declining rates for therapy and people in other fields administering our assessments. I mean, if a bachelors level person can do it, why can't a speech/language pathologist or vocational therapist?
To use neuropsych as an example, let's be honest: We've all seen people essentially take a dump on a few pieces of paper, write "neuropsychological assessment" on it, and charge $3000 dollars for it. We also have created a model where many of the "attendings" spend less than five minutes with a patient and have trainees do the rest, all while billing out for top dollar. I am not surprised that insurance companies don't want to reimburse with the frequency that I encounter it doing chart reviews, and I doubt that high cash fees will remain an option forever either without better quality control.
That quality control begins with individuals managing their practices, and I am sure that the business side of things will get in the way of quality control all to often. I don't expect people to do the right thing.
I suppose my problem would be with someone say, beating the drum against mid-level encroachment, and then turning around and hiring a bunch of master's level clinicians at their private practice. Do as I say and not as I do...and TBH, I think that has been the case far too often here in this field. By the time people pay their dues and do get established, they figure they've earned it at this point and it is okay to cut corners/hire cheaper staff/etc.
Edit: Not saying that everyone practices that way, but I have observed it plenty. I think part of my wariness about private practioners in general is the fact that I see the most crap come out of private practice. It is too unregulated.