See outpatients privately or through employer

[SmallBird]

My current practice is entirely inpatient and emergency psychiatry. These interests have tied me to systems, and although I am as cynical as the next person in this regard, I have through repeated moves and shuffles ended up in a pretty good system.

As I plan to move back into some outpatient work, I'm trying to decide whether taking private patients is going to offer an advantage over simply doing this through my employer as well. Doing outpatient work through the system would mean 1) It would entirely be from home (virtual only); 2) $60/rvu guaranteed; 3) no overhead; 4) built in crisis support (all the outpatient doctors have the same process in place and the hospital has these psych 'urgent cares' people can go to outside of office hours). There would be some disadvantages related to being able to select the patient population, having to use a clunky EMR, etc etc. Doing it privately would mean 1) From home but perhaps a home office, 2) I believe the market could bear rates of around $250 for a follow-up and $400 for an intake, 3) I'd have to do all my own scheduling etc and pay different taxes etc.

Any thoughts? I'm leaning towards thinking that I could just work through my employer and have close to what I want (there is zero issues with stuff like pressure to do volume or length of visits etc., that is all entirely up to me).

---

Members don't see this ad.

 

[forchinet121]

Virtual doesn’t sound interesting though is that what you prefer or can you do it in person?

 

[SmallBird]

Virtual doesn’t sound interesting though is that what you prefer or can you do it in person?

I can do it in person if I prefer. I've come around to virtual with the technology being so much better now.

 

[Jules A]

If you like outpatient and don't mind having limited control over who is on your docket it might make sense to remain in your current system or at least try that out first. If you want to have your own business and are willing to wait the time it takes to ramp up an out of network practice there are some pros. In my experience the out of network patients tend to be pleasant and high functioning. They are able to afford whatever you might recommend to aid in wellness such as out of pocket DBT groups, rehab, gym memberships etc. There is minimal difficulty getting them to obtain diagnostics as requested. My patients with SMI tend to be children of affluent people so the same applies. There are some tax/retirement advantages to being self employed. Some cons could be the ramp up time, likely need for an office even if only a few days per month and having to do your own weight/vitals. The charting, scheduling, follow up texts, misc. admin tasks like PAs, faxing school med consents, lab slips and requesting medical records account for approximately an extra 15mins/30mins of my time for each med-check/eval. If you are interested in having your own business it can be a pleasant and lucrative side gig.

 

[trophyhusband]

Tax breaks for owning your own business are wildly overblown IMO but adding a solo 401k on top of whatever you can put away for your employed position might be worthwhile for you.

 

[Stagg737]

Interesting situation, thanks for the thread.

My primary question/concern is how much more leverage does the system gain if you work through them for outpatient? My concerns would be the amount of time given or required for one of those responsibilities at the expense of one of the others you prefer more (ie, we want you to see more outpatients, so we're only giving you X hours to complete your inpatient duties). On the flip side, if you do your own private outpatient, will they see you as a competitor and try to increase your other responsibilities or hours to limit your outpatient time?

 

[Sushirolls]

Another angle is longevity. How likely are you to move or stay put?
If you've been changing jobs in the past often, then you might be able to project another likely transition?

Having the patients with the employer means of ease of exodus. And you get to dip your toes back into outpatient world. Could use as opportunity to make pro/cons list of work flow for a future PP. Employed could be the more cautious means for re-entry into OP.

Or if you already know you are okay with OP and maybe already know you want more, or to transition just to OP, then getting your PP going down could be good. Do enough to shape your policies, shape your work flow, establish some core patients. Then if/when you move in the future you have a portable practice. [I'm sort of doing this now as I'm in transition moving into another state] Plus doing it now, you get to have your learning curve while still employed instead of starting from ground 0 with nothing. Conversely, if you already know you are going to move again, then maybe waiting on your own PP is best - less headache of needing to transition to another state all your factoids and contracts.

What's your longterm goal, aim, desire?

 

[Bartelby]

Another thought: do you want to do a lot of psychotherapy? Or are you focusing on briefer (typically 30-minute visits)? Doing hour-long E&M + therapy in an RVU system is rough, it reimburses just over half of what you would get for two 30-minute E&M plus brief therapy visits. In out of network private practice you can get better reimbursement for hour-long visits.

If you just want to try out, say, 4 hours per week of standard shorter appointments then the employer route is certainly easiest. On the other hand, starting your own PP gives you a sense of whether you like it in case you decide to go that route later.