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Discussion in 'Psychiatry' started by vistaril, Apr 7, 2013.

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  1. vistaril

    vistaril

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    besides just fee for service direct pt/third parter billing....are there any??

    Yes, I know we can hire lpcs and such on salary, but this is usually less advantageous(and sometimes a loss leader) than just referring to them(and getting referrals in the other direction).....simply because if they aren't getting to bill for themselves they are going to want benefits and with those and the payroll tax for them there just isn't enough margin there after their salary.

    The lack of ancillary service possibilties and other revenue streams is what is holding our salaries down...and unfortunately I can't think of any.

    when you look at the numbers comparing us to outpt family med, internal med outpt, etc...the pt pt billing codes are fairly similar and(if you dont do therapy) the time interactions are probably similar, but there is room for an entrep fm or IM guy to branch out and make a s***ton on ancillary services, other revenue streams, etc.....

    just right now in the fam med forum there are several guys doing over 400k in net profit with such streams, including one at 600k due to other revenue streams and optimization of inhouse labs.....

    the lack of possibilities in breaking away from per pt fee for service stuff(whether you are seeing medicare, insurance, or cash pay pts) is frustrating....I mean I knew all this going in, but watching other providers(including other providers like fm whose 'reported' salaries are also at the bottom with us) making gobs of extra money from ancillary services and such is disheartening.
  2. kumar28

    kumar28 Senior Member

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    Ha..another dumb post by vistaril..seriously you cant think of ancillary services for psych. Dude the private place where I am working profits majorly off of these services..you're seriously a moron to even post this....

    oh wait..you ignored me so you wont see this anyway

    Seriously...what is this guys deal??
  3. SmallBird

    SmallBird

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    Well, I know of a number of psychiatrists making quite a bit extra through entrepreneurial means, but I'm very hesitant to provide examples - will you not simply try and criticize any responses provided?
  4. vistaril

    vistaril

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    no Im interested....but I'm not talking about just contracting out for addl consulting work or whatever(which amounts to per hour work)......I'm talking about real revenue streams-like when an internist has contracts with a lab or when they do inoffice labs, or when a GI group does in office pathology and takes all the TC and much of the PC. Things that are revenue streams which can be incorporated into existing practice model(or with some tweaks).....I'm *not* talking about a psychiatrist contracting out with a local jail to work for 135 bucks an hour or whatever and see patients(thats same model, different setting, no addl revenue stream)
  5. TexasPhysician

    TexasPhysician Moderator

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    Spa psychiatry is all the rage now. Nails, massage, psychotherapy. The only downside is the men asking for "extras" keep getting put in seclusion by the massage therapists. We initiated a $25 fee for wives to get their husbands out, but they kept leaving them in there.
  6. vistaril

    vistaril

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    ha...on the one hand Im laughing because this was funny and creative. otoh I'm getting jealous thinking of all the pcps(not to mention derms of course) out there who do cash in on some very low hanging fruit in these areas by bundling some of these things into the more medically oriented services they provide.
  7. F0nzie

    F0nzie

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    I'm confused. You went into one of the lowest paid medical specialties and are wondering how to make 400k-600k? :laugh:

    Stay at home so your GI fiancee can buy you pretty little things.
  8. TexasPhysician

    TexasPhysician Moderator

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    Who says you can't? Outer and inner beautification by Vistaril.

    Just learn from my mistake and charge wives to keep husbands in seclusion and not the other way around. Otherwise you are providing free hostel like amenities for the men.
  9. TexasPhysician

    TexasPhysician Moderator

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    I'm getting screwed then. My wife just gives me the baby with a less than pretty surprise wafting through the air.
  10. vistaril

    vistaril

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    yeah I know it's not like I didn't know.....ny point was that the other 'low paid specialties' still have some workable revenue streams(to potentially get out of the low paid category)....I'm just lamenting the fact that psychiatry doesnt have those.
  11. TexasPhysician

    TexasPhysician Moderator

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    I'll go in with you on a bakery that laces all goodies with neuroleptics. Compliance - 100%.
  12. F0nzie

    F0nzie

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    That's why I was saying... your GI fiancee is going to strike gold and make some serious bank. You don't need to worry your pretty little head over things like ancillary services. She'll take care of you. :)
  13. vistaril

    vistaril

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    well we're doing money separate....so I do need to worry about such things!
  14. NJWxMan

    NJWxMan

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    I personally am friends with several psychiatrists that make around $400-500K per year. They work very hard and complete many moonlighting hours in psychiatric ER's and outpatient clinics. The money is certainly there if you are willing to put in the time. A 30 year old single psychiatrist can easily work 2-3 years in this fashion (before marriage) out of residency, hustle, pay off loans, and put a bit of money away while living with their parents.
  15. billypilgrim37

    billypilgrim37 Unstuck in Time

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    How do you get married if you're working that much? Most partners want to see who they're marrying before they marry them. Mostly.
  16. PrideNeverDie

    PrideNeverDie We're all gonna make it brah

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    normal people think the same things about people getting married in residency

    "how can you know he or she is the one when you're working 80 hour weeks at the hospital?"
  17. vistaril

    vistaril

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    but that's not an additional revenue source....thats just working 4000 hrs in a year at $100/hr in various settings(and a lot of that work is going to be unpleasant, boring, bad hours, etc).....anyone can do that. A pharmacist can hop around to different chains and do that(well and make 65 bucks/hr instead...same principle).....

    the problem as I see it is there are no other streams of revenue. That's a bummer.
  18. billypilgrim37

    billypilgrim37 Unstuck in Time

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    And they're probably right!
  19. heyjack70

    heyjack70 Junior Member

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    1. Become a cannabis dispensary, or add one to your practice, in a medical marijuana state.
    2. Sell vitamins, naturopathic, and homeopathic treatments.
    3. Sell exercise videos, or whatever, for behavioral activation motivation.
    4. Sell light boxes.
    5. Have you clinic double as a yoga studio, for behavioral activation.

    .
    .
    .
    .
    6. Buy property in a country that won't extradite you to the US; preferable with a nice climate and near the beach. "prescribe" lots of drugs with a high street value (receive kickbacks). Play this candyman lottery for as long as you can stomach it. Retire to previously named country.
  20. vistaril

    vistaril

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    none of these are mainstream or within really the standard of care...
  21. heyjack70

    heyjack70 Junior Member

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    I think you're right about them not being within the scope of standard care (depending on where you live alternative treatments could be widely accepted and offered). Though there is evidence for light therapy and behavioral activation. No risk, no reward I say.



    7. Buy a SPECT scanner and open an Amen-esque pseudo science ADHD and bipolar diagnosis center.
    8. Have a phlebotomist in your office and make sure you are aggressively screening for side effects and serum drug levels. Helps if you prescribe a lot of atypicals and mood stabilizers. So, become the bipolar specialist in town. The SPECT scanner might help with that.
    9. Buy an old CT scanner from the Philippines; scan everyone with possible first break psychosis.
    10. Rent office space to social workers and psychologists. Charge a percentage of their collections. Make sure to keep businesses separate to minimize headache.
  22. F0nzie

    F0nzie

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    I am fascinated by listening to my friend in surgery tell me about his relationship problems. He has been dating another surgery resident for 3 years but it's like they've only known each other for 2 weeks.

    If he paid me to listen, that would be a good source of ancillary income.
  23. vistaril

    vistaril

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    7) who is going to pay for this?
    8) this would be a money loser. You're not going to have the volume to break even with a lab contract like that.
    9) wont get reimbursed, and who is going to read from an 'old ct scanner from the phillipines'
    10) This is a decent idea....but you have to own the building. I mean if you own the building, you've got a ton of capital to start with and can rent it out to anyone.
  24. notdeadyet

    notdeadyet Still in California Moderator

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    I think the "living with the parents" would be a much bigger red flag to potential lady friends than the "working too much."
  25. kumar28

    kumar28 Senior Member

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    ok..vistaril has to be the biggest douchebag I have ever seen in the history of forums..sorry..I'm name calling..i just can't stand it. I bet you he's got asperger's or something (not that Im saying people with aspergers are douchebags..just vistaril)

    There are a ton of other revenue sources. The private psych/addictions hospital that I work at is a prime example of this. Im not going to name them off because people who work in psych know what they are. PM me if you want more info

    In all seriousness though reading these posts by vistaril are just laughable now...takes away from what used to be a credible forum....moderator??
    Last edited: Apr 10, 2013
  26. heyjack70

    heyjack70 Junior Member

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    Come on, man! Do I have to do everything? I'm the source of these paradigm changing ideas. I'm giving you free gold nuggets and all you do is complain. If you can't figure out how to pay for it, I guess you're just not worthy of being the world's best and richest psychiatrist.
  27. TexasPhysician

    TexasPhysician Moderator

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    I agree. Ancillary services paid by insurance companies are not going to bring in much additional $. You have to sell a better experience/options to bring in additional revenue. Involving yourself in basic lab work is a waste of time in my opinion.

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