Private Practice future?

[psych84]

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So how do you guys see the future for private practice?
For those of you who have one now, what do you think?


I'd also love to hear from people in private practice from Canada as we don't neccesarily have to deal with some of the issues that exist in the US.

 

[WisNeuro]

I imagine it's very situation/city dependent. I am also curious to hear how PP is evolving in the era of the ACA. I'm at a VA, so my referral source and work is fairly set.

 

[erg923]

Private practice of what? The Financial viability of a practice is dependent on services offered. Provision of general psychotherapy services is most financially constrained at this time.

 

[psych84]

Private practice of what? The Financial viability of a practice is dependent on services offered. Provision of general psychotherapy services is most financially constrained at this time.

So stick with assesments and you can make money?

 

[WisNeuro]

So stick with assesments and you can make money?

Definitely easier to bill insurance, at least in some instances. Especially if you do forensics.

 

[psych84]

And what is defined as general psychotherapy?

 

[WisNeuro]

What do you mean?

 

[psych84]

What do you mean?

I guess I meant to say is it difficult to have a private practice that is therapy driven no matter who is providing the psychotherapy? Ie (Psychiatrist, Psychologist, psychotherapist, counsellor)

 

[WisNeuro]

Psychiatrists offering therapy are definitely the minority there. Not as lucrative for them unless they are charging rich yuppies exorbitant amounts to do psychoanalysis and not get better. Most stick to med management from what I have seen. As for the others providing psychotherapy, depends on your niche and your market I would imagine. One of the biggest hurdles historically has been getting insurance companies to pay and the fact that Medicare/Medicaid usually doesn't pay enough to meet your overhead fees in PP.

Like I said, I'm curious to hear from someone out there if the ACA is better for them, although it may be too soon to tell.

*Disclaimer. I have been in the federal system for the past 3 years, so my experience with PP and private clients is limited to past experiences as a trainee in those settings.

 

[erg923]

So stick with assesments and you can make money?

I think the point was, you need to be more specific and/or narrow the question.

Obviously, the financial viability/profitability of a business is highly dependent on the owner, the employees, what service is offered, and the efficiency of that service, right? There is also little doubt that the more third-party payers control the reimbursement structure, the more limitations will exist in PP earnings. Are there ways around that? Of course- If one evolves their practice.

 

[ikibah]

It definitely varies GREATLY. There are some therapists that I know who are running a private practice (happens to be they do not work through insurance) doing solely psychotherapy and making a killing....I repeat...a killing. On the other hand I know others who are in pp and are struggling greatly to support their families at all. It depends on your skill level, marketability, location, niche, etc.

 

[docma]

It definitely varies GREATLY. There are some therapists that I know who are running a private practice (happens to be they do not work through insurance) doing solely psychotherapy and making a killing....I repeat...a killing. On the other hand I know others who are in pp and are struggling greatly to support their families at all. It depends on your skill level, marketability, location, niche, etc.

There will probably always be a market for private practice and it will vary as noted above. As long as there are psychologically minded folk with large enough discretionary income who are suffering, they will seek out private practitioners. For early career psychologists, I think the questions really are: do you want to be in business independently and learn the details of marketing, accounting, billing, etc. Private practice is a business and takes time commitment, organization, networking, and the ability to be comfortable with the liability and everyday demands.

 

[psych84]

I'm trying to understand all the costs..
Obviously you have rent, cost of administering tests, marketing, accounting, possibly if an employee is needed (i would think a forensic practice would for sure need someone), and supplies?

What percent of total cost would be attributed to each of those categories? (for those of you with a PP) Is rent usually 50-60% of total costs?

 

[Therapist4Chnge]

They have countless books published on how to set up a (med/psych/other) practice. It'd be easier to buy a few books than try and figure it out on here. A very ballpark goal (and it depends on geographic location, amenities, etc) would be less than 30% of total revenue gets earmarked for overhead. It'd be much higher in NYC and much lower in Iowa City. Additionally, how you define overhead would impact the %, as hard costs like mortgage and utilities are always considered part of the overhead, while marketing may or may not get lumped in.

 

[psych84]

They have countless books published on how to set up a (med/psych/other) practice. It'd be easier to buy a few books than try and figure it out on here. A very ballpark goal (and it depends on geographic location, amenities, etc) would be less than 30% of total revenue gets earmarked for overhead. It'd be much higher in NYC and much lower in Iowa City. Additionally, how you define overhead would impact the %, as hard costs like mortgage and utilities are always considered part of the overhead, while marketing may or may not get lumped in.

Any book suggestions?

 

[Sanman]

There is a lot more than rent to consider. Does the place need to be furnished? Power? Will you have an office assistant? Who is doing the billing? Computers or written pt records. Where will you store old pt records? How much is an electronic program for notes that is HIPAA compliant? Who/how are you billing? If you take medical insurance who is doing your billing? Will you take credit cards? How much does it cost to keep a credit card machine? Malpractice insurance costs, coffee maker/ coffe(will you offer free coffee?). Will you pay for a cleaning service for the office? Just a few of the many concerns of a business owner.

 

[IT514]

Any book suggestions?

The Business of Neuropsychology is worth a look.

Anyone here consider PP right out of post-doc, starting one or joining at a partner level? I'm considering a few options, some more solid, some more safe than others, but the most appealing in terms of long-term benefit and personal flexibility appear to be PP. I could be wrong. Could be that I'm getting sick of having a pager attached to my hip and that I value autonomy, but I'm really leaning toward PP at this point.

 

[AcronymAllergy]

The Business of Neuropsychology is worth a look.

Anyone here consider PP right out of post-doc, starting one or joining at a partner level? I'm considering a few options, some more solid, some more safe than others, but the most appealing in terms of long-term benefit and personal flexibility appear to be PP. I could be wrong. Could be that I'm getting sick of having a pager attached to my hip and that I value autonomy, but I'm really leaning toward PP at this point.

I know a few folks who went straight from either internship or postdoc to PP, although I think they all joined existing practices rather than attempting to start their own. Their experiences have been pretty much as mixed as what's listed here--some do well, others definitely struggle (to fill their schedule, to make ends meet in general, to deal with rough revenue splits, etc.). You're of course almost always going to make more money if you're an owner or part-owner and have multiple folks working for you. However, the early career people I know who opted to start their own practice struggled with the steep learning curve. Then again, those folks also started in non-PP settings (e.g., VA, AMC); it might've been a less jarring transition if they'd actually had previous group PP experience.

 

[Therapist4Chnge]

I've seen (anecdotally) a number of people transition from a night/wkend/part-time setup to a full-time practice with some pretty good success. If you work in an area of need (either speciality or # of limit providers), then finding a pool to draw from is easier; it can also be very geographically dependent. Getting on insurance panels can take months, so jumping right into PP may be difficult. I personally wouldn't recommend a solo PP right out of post-doc/fellowship because there can be a steep learning curve in regard to the business side of things (e.g. dealing with insurance companies, registering a biz, taxes, etc).

 

[IT514]

The thing is where I am looking is pretty ripe, and I do have a number of connections, some who are willing to help with starting-up my own thing but essentially a back seat in terms of risk, some who definitely are looking for a split in their favor though they are giving a bit more in terms of a consistent referral stream and overhead with eventual partnership. I do have a safe option to stay where I'm doing my fellowship, so I'm using that to set the bar in terms of take-home pay, though benefits will likely be tough. And if all else fails I can always live in a van down by the river.

 

[cab1234]

Definitely easier to bill insurance, at least in some instances. Especially if you do forensics.

You cannot bill insurance for forensic services. You're paid by the attorney in most cases (or the judge in others).

 

[WisNeuro]

You cannot bill insurance for forensic services. You're paid by the attorney in most cases (or the judge in others).

Should have broken my statements up. I was conferring two separate ideas, but I didn't do a good job of it. Billing insurance for assessment work is sometimes easier bc we bill for large blocks of time instead of a bunch of tiny blocks. And as an outside thing, we can make a good deal of money in the forensic setting from a variety of sources.

Although we do get hired by insurance companies for record review (not just by lawyers and judges), and that pays pretty well in many cases.

 

[erg923]

Should have broken my statements up. I was conferring two separate ideas, but I didn't do a good job of it. Billing insurance for assessment work is sometimes easier bc we bill for large blocks of time instead of a bunch of tiny blocks. And as an outside thing, we can make a good deal of money in the forensic setting from a variety of sources.

Although we do get hired by insurance companies for record review (not just by lawyers and judges), and that pays pretty well in many cases.

Can you discuss what, specifically, "record review" consists of for insurance companies? What would I do after reading said records if i am not actually seeing a patient. Same for "record review" with lawyers/law firms. Should I assume all SSDI lawyers need to have a psychologist or psychiatrist on their payroll? Seems like they would?

 

[WisNeuro]

Can you discuss what, specifically, "record review" consists of for insurance companies? What would I do after reading said records if i am not actually seeing a patient. Same for "record review" with lawyers/law firms. Should I assume all SSDI lawyers need to have a psychologist or psychiatrist on their payroll? Seems like they would?

The general gist of it is that you review an assessment made by another neuropsychologist. If they did a ****ty job (used the wrong instruments, overlooked obvious malingering, used inappropriate norms, etc.) you cite the relevant literature and write a summary of problems with the assessment. You are not assessing the patient, rather assessing the provider really. There are a lot of by name only "neuropsychologists" out there who ***** themselves out to personal defense attorneys and do shoddy evals to help someone scam a lot of money. I would have no problem helping out the insurance companies in those cases.

 

[smalltownpsych]

I work in a a hospital-affiliated outpatient clinic that is run much like a private practice. It works out well because we get a lot of referrals from the other docs. I also get referrals from community providers who do not always feel competent to treat or are looking to work collaboratively with more severe or complicated cases. I have been working here since March and my schedule is getting pretty full. It takes time to build up a practice and having the support of a hospital really helps. My plan is to look at an independent private practice option about 5 years down the road. I don't think it would have been a good idea for me to jump straight into private practice right after school or licensure. My opinion is that developing expertise in the field of psychology takes a lot of time so don't feel the need to rush it.