Oh forgot to mention this. Your malpractice insurance carrier and your local APA branch may be able to answer what the standard is in your area.
I find that A LOT of psychiatrist are not doing this and nothing comes of it.
I have found plenty of doctors not following the rules and getting away with it. If a doc doesn't follow the rules, the only way to stop him for things to happen that rarely do. E.g. the state board revoking their license.
But if you choose not the follow the rules, you do so at your own risk.
E.g. I knew a doctor that folded his practice and refused to give his patients their records even when they requested it. Is this illegal? Yes, but if the patient called the police, the police blew them off saying it was between them and their doctor. You call a lawyer, the lawyer will only pursue getting your records at a financial cost to most people not worth it.
1 - Do you do any screenings before you accept patients? Do you check for any history of violence before accepting a patient? Maybe checking for felonies online or something ...
2 - How do you fire a patient? Do you do this a lot?
You could screen a patient though in doing so, you could technically become their doctor. Just talking to someone about anything medical could tie them to you in a doctor-patient relationship.
Firing a patient? Depends on the local state laws. In Ohio, if you terminate a patient, you have to send them two letters, one through certified mail, the other through regular, you have to keep a copy of the certified mail receipt, and you have to offer them one month's worth of medication. If you fold a practice, this in effect terminates all patients, but you have to put a sign in the office saying your'e stopping the practice at a future date, you have to mail every single patient a letter via certified mail, and you have to put an ad in the local paper with the highest circulation stating you are folding your practice. In other states it varies. E.g. in some states you are required to refer the patient to three other doctors.
Or as Phil Resnick puts it.....
"If you terminate a patient, you likely find this patient very difficult to deal with. Therefore, when you terminate them, you refer them to three psychiatrists you don't like because the last thing you want to do is drop a bad patient on someone you do like."
Yes he was being sarcastic, though it's funny because this is what most doctors do and don't admit to it.
My advice in this area is if you do a practice, get together with psychotherapists and have them refer their patients to you. Psychotherapy-only patients tend to be less severe in pathology. E.g. psychotic patients usually don't see psychotherapy only services. When I did private practice, I had one of the psychotherapists do the 24/7 emergency coverage for me, and he was supposed to call me if he couldn't handle it. This limited the calls I got to maybe only 1-2 per month instead of 4-5 a night. We were able to pay him at a wage that was relatively cheap considering he was taking the work off a doctor's shoulders. We all won. The psychotherapist made extra money, I didn't have to deal with it, and it didn't cost much.
I will probably do 24/7 availability but in a limited way for emergencies only
It's perfectly acceptable to tell a patient to not call you unless it is an emergency. Also, IMHO, don't be too strict with good patients. Sometimes patients won't call you in an emergency if you get too hard on them for doing so. They'll not know if it's an emergency or not. E,g. a patient with a bad rash from Lamictal IMHO is an emergency but if you create a culture that they can never call you unless the world end, they might not do so when it really is one. By the time you've had a patient for a few months, you'll know who the problem ones are vs the responsible ones. I'd rather charge someone for repeat offenses. I have plenty of great patients that for years were low maintenance, then something terrible happens to them and they'll need a little more support than usual and phone calls can help them a great deal.
As for charge them a high fee, I better double check on this. I think you can do this, but I'd rather check before I tell you it's okay.