I can almost guarantee this is nowhere near the entire picture. I think the problems Doctor Eliza is talking about have their origins in quips like this--anectodotal assumptions about what someone makes based on what they charge. I'm sorry, but it's naive. More evidence that psychology students really don't know what the business of private practice is all about.
Agreed ^
On paper, the PP I work for charges $150/hour for testing & therapy, and is booked solid for the next several months, so a quick calculation (150*40*4*12=$288,800/year) would make his practice seem lucrative; however, the vast majority of our clients are insured by Medicaid. Suffice it to say that Medicaid reimburses over $100 below our typical $150/hour rate, and it's sad because in order to turn any kind of a profit, our caseload is outrageous. Not only is there a 3-6 month wait for initial consults, but after that it take's roughly another 2-3 months to get the precertification done, which often includes over half of the testing requested being denied. Granted that we are involved in a number of unique contracts, and we see a number of clients for forensic evaluations, which we often charge over $500 for a 2-4 hour visit, but these visits are the exception and not the rule. Furthermore, many pre psych students are under the impression that full time PP work includes being paid for a full 40 hours of work per week, when as anyone who has worked in a PP knows, there is so much behind the scenes work being done, that a doc wanting to spend no more than 40 hours a week in the office would be lucky to get 30 hours of actual billable time done per week, depending on how much he's willing to spend on administrative staff to handle his scheduling, billing, testing, general management, etc.
The doc I work for has 3 other docs (1 licensed, 2 unlicensed) under him and a psychometrist to administer his testing, so the actual FTF time with the doc is minimal. I had a client this morning complaining because he met with the doc for 15 minutes 6 months ago and is just now getting his evaluation done, but this is the reality we live in. Additionally, our office has 2 secretaries (one does front end work/other does billing), a practice manager, and a 3rd party to handle issues with insurance, so really whatever money comes in our office per hour, a large chunk of that is going out to compensate the office staff.
I had originally thought that PP was for me, but the more time I spend here, the more I realize that I miss working in a research environment and would probably enjoy academia as well. The doc I work for is much more business minded than practice minded, and the more I've learned about his practices, the more I've started to question the ethics of the field. Current insurance reimbursement rates make it difficult to truly have a patient's best interest at heart especially when your caseload is where our's is. I think it's crucial for all psych students to see what it's like to work in a lab AND a PP on a full time basis before deciding what they actually want to do with their doctoral degree.
