All Things Private Practice -- Q&A

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foreverbull

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As someone who asks and answers private practice questions in here frequently, I think it would be helpful to have a catch-all thread to cover everything from ethics to marketing to income to insurance--whatever questions people have as an ongoing thread like the VA venting and support one.

I'll start: professional wills. My spouse/colleague is the default administrator in the event of my death, so I'm not sure if we need another outside of our practice. I suppose in the highly unlikely event of both of our sudden deaths simultanousy, we may need one, perhaps. What do you all think about professional wills in general?

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I thought that was what this was for:

Private Practice Olio

Either way, it may be worth it to have the mods merge this stuff as I, for one, would love a PP guide on here.

EDIT: Are the Sticky threads gone with the new update?
 
I thought that was what this was for:

Private Practice Olio

Either way, it may be worth it to have the mods merge this stuff as I, for one, would love a PP guide on here.

EDIT: Are the Sticky threads gone with the new update?
They're now over on the right under the Psychology Favorite Threads header after a recent forum update.

If folks want us to try to merge some of the PP threads, we can certainly try.
 
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Sounds like a lot of "someone else's problem". If you want to be nice, then a professional will can help people locate their medical records. Risk wise, it's basically a non-issue. The worst a patient can do is sue your estate for malpractice. That only applies if your estate is still in probate AND you cheaped out on malpractice insurance. What are the chances someone learns you're dead, finds an attorney who can file suit before your estate clears?

* this is one of the reasons I won't see pediatric subjects. The record retention laws would mean I would have to keep that stuff up for almost 20 years after I retire. No thank you.
 
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I thought that was what this was for:

Private Practice Olio

Either way, it may be worth it to have the mods merge this stuff as I, for one, would love a PP guide on here.

EDIT: Are the Sticky threads gone with the new update?
Whoops--I forgot this existed. Yes, if we can merge the threads and have just one of them be a sticky PP thread, that'd be great.
 
Sounds like a lot of "someone else's problem". If you want to be nice, then a professional will can help people locate their medical records. Risk wise, it's basically a non-issue. The worst a patient can do is sue your estate for malpractice. That only applies if your estate is still in probate AND you cheaped out on malpractice insurance. What are the chances someone learns you're dead, finds an attorney who can file suit before your estate clears?

* this is one of the reasons I won't see pediatric subjects. The record retention laws would mean I would have to keep that stuff up for almost 20 years after I retire. No thank you.
I have to say I'm shocked to hear you say this as someone who interprets the ethics code far more conservatively than most here.

APA Ethical Principles of Psychologists and Code of Conduct (“Ethics Code”) Standard 3.12 addresses both expected and unexpected interruptions of treatment as follows: “Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the
event that psychological services are interrupted by factors such as the psychologist’s illness, death,
unavailability, relocation or retirement or by the client’s/patient’s relocation or financial limitations.” In addition, Ethics Code 6.02(c) states: “Psychologists make plans in advance to facilitate
the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists’ withdrawal from positions or practice.”

That said, I completely agree that this should be a non-issue in terms of actual liability, but APA is pushing for creating professional wills as the ethical thing to do.

How many other professions place burdens of having to worry about clients and their care after you die?
 
I have to say I'm shocked to hear you say this as someone who interprets the ethics code far more conservatively than most here.

APA Ethical Principles of Psychologists and Code of Conduct (“Ethics Code”) Standard 3.12 addresses both expected and unexpected interruptions of treatment as follows: “Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the
event that psychological services are interrupted by factors such as the psychologist’s illness, death,
unavailability, relocation or retirement or by the client’s/patient’s relocation or financial limitations.” In addition, Ethics Code 6.02(c) states: “Psychologists make plans in advance to facilitate
the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists’ withdrawal from positions or practice.”

That said, I completely agree that this should be a non-issue in terms of actual liability, but APA is pushing for creating professional wills as the ethical thing to do.

How many other professions place burdens of having to worry about clients and their care after you die?

I am with PsyDr on this one. I might include in a will instructions on the proper destruction of records. However, APA always seems to want to put a lot of burdens on clinicians (this, sliding scale, efforts to help clients find new therapists) while doing little to ensure we are financially well off enough to handle all of those demands that pay nothing. Having seen much larger fish ignore most of these issues, I am not much inclined to worry about things after I am dead.
 
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My state requires a professional will in order to get licensed and to renew licensure; there’s a specific question asking if you have prepared and maintain a professional will on our license application and renewal.

It is rather easy to do and a good idea to have regardless whether your spouse is also a colleague and if you have specific directives established in your trust or will.
 
I have to say I'm shocked to hear you say this as someone who interprets the ethics code far more conservatively than most here.

....

How many other professions place burdens of having to worry about clients and their care after you die?
1) It's more of a legal issue, than an ethical one. Like laws prohibiting suicide, they can't enforce them if you're dead. I don't know how that works if you're no longer licensed.
2) The APA is a professional and secular organization, that uses an arguably deontological approach to ethics. This is a problem for them.
a. When I'm dead, I'm no longer in the profession. Therefore my professional identity and duty are done, and the ethics don't apply anymore. If they want to replay the Cadaver Synod, they can have at it.
b. Part of what makes something a "profession" is payment. They cannot say I'm in a profession, but demand that I not be paid. Likewise, they cannot force a colleague to do free work for me. This is different than the legal argument.
3) The idea that you can plan for the unexpected is a logical fallacy. How many people have professional wills that cover the possibility of being eaten by a T-Rex?
4) Because of the other ethical requirements regarding such things as competence and boundaries, it's impossible to ethically demand availability, without limits.
5) Again, I think it's a good idea to follow the legal requirements for records. I think it's a nice thing to do for patients, within limits. I don't think it's an ethical issue.
 
My state requires a professional will in order to get licensed and to renew licensure; there’s a specific question asking if you have prepared and maintain a professional will on our license application and renewal.

It is rather easy to do and a good idea to have regardless whether your spouse is also a colleague and if you have specific directives established in your trust or will.
I have not encounter this, and I am licensed in 5 states-4 of which i don't actually live, obviously.

How would this even work? How do I know Dr. X/Group X would even be alive/competent/functioning when i die? What's the back-up there? And if I did, how do I know they would able to treat/accept/see a hypothetical flood of varied psychiatric patients that he/she knows nothing about? They just have to "agree" years before hand? Can these patients pay this person? Who would ever agree to sign something like this from another practitioner? I wouldn't! I thought this what the community mental health system in this country was for?
 
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I have not encounter this, and I am licensed in 5 states-4 of which i don't actually live, obviously.

How would this even work? How do I know Dr. X/Group X would even be alive/competent/functioning when i die? What's the back-up there? And if I did, how do I know they would able to treat/accept/see a hypothetical flood of varied psychiatric patients that he/she knows nothing about? They just have to "agree" years before hand? Can these patients pay this person? Who would ever agree to sign something like this from another practitioner? I wouldn't! I thought this what the community mental health system in this country was for?

I am guessing you just check a box and they can take remove your license to practice if you die and have no professional will...oh wait. I really want to know how they plan to enforce punishments for that.
 
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Is anyone willing to share a template (excel spreadsheet?) of how they track their patients/income/expenses, etc? (for anyone who does NOT use quickbooks for tracking but instead does it themselves)

I've got a MESS of a situation now trying to track income, appointments, etc and am looking to revamp my process to be clearer and more streamlines.
 
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I am guessing you just check a box and they can take remove your license to practice if you die and have no professional will...oh wait. I really want to know how they plan to enforce punishments for that.
I am more interested in who does/would sign-off on something like this? Like, maybe a regional/tertiary AMC or CMH org....maybe?

But how to get a solo practitioner or a larger group practice to actually sign such is thing beyond me???
 
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I've heard of this before. In those situations it was kind of an i'll be yours if you be mine kind of deal.

Great, so now I am required to be a licensed psychologist and have friends, but not too many as then I would be everyone's professional executor.
 
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I have not encounter this, and I am licensed in 5 states-4 of which i don't actually live, obviously.

How would this even work? How do I know Dr. X/Group X would even be alive/competent/functioning when i die? What's the back-up there? And if I did, how do I know they would able to treat/accept/see a hypothetical flood of varied psychiatric patients that he/she knows nothing about? They just have to "agree" years before hand? Can these patients pay this person? Who would ever agree to sign something like this from another practitioner? I wouldn't! I thought this what the community mental health system in this country was for?
From what I’ve seen, I don’t think the expectation HAS to be for the “backup” psychologist to treat them in case of death, but notify the clients the psychologist is dead or incapacitated and hold on to the records for 7 years as well as the passwords to records/software/website to “close” the practice by notifying the companies that provide services to the business.

The template APA provides is definitely a bit on the “too thorough” side when it says if it’s appropriate, can treat, OR provide referrals and forward records along for all active clients who will transfer to a new therapist. I’m not sure if this is an expectation? Although not likely to happen for many, this would be extremely time-consuming for the named executor if the worst happened. The APA template even says something about contacting past clients (inactive) to notify them.

This job sounds terrible if you actually have to do it. Can you imagine in the midst of your own practice just adding another job temporarily without pay (and if you stipulate pay, won’t it be messy to rely on the next of kin to have to pay you)? That said, what is the likelihood it would actually be needed?

Here’s the APA template for those interested:

As expected, APA seems to go overboard by including too much rather than too little in terms of executor tasks and functions.
 
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From what I’ve seen, I don’t think the expectation HAS to be for the “backup” psychologist to treat them in case of death, but notify the clients the psychologist is dead or incapacitated and hold on to the records for 7 years as well as the passwords to records/software/website to “close” the practice by notifying the companies that provide services to the business.

The template APA provides is definitely a bit on the “too thorough” side when it says if it’s appropriate, can treat, OR provide referrals and forward records along for all active clients who will transfer to a new therapist. I’m not sure if this is an expectation? Although not likely to happen for many, this would be extremely time-consuming for the named executor if the worst happened. The APA template even says something about contacting past clients (inactive) to notify them.

This job sounds terrible if you actually have to do it. Can you imagine in the midst of your own practice just adding another job temporarily without pay (and if you stipulate pay, won’t it be messy to rely on the next of kin to have to pay you)? That said, what is the likelihood it would actually be needed?

Here’s the APA template for those interested:

As expected, APA seems to go overboard by including too much rather than too little in terms of executor tasks and functions.

If there is more of a push to mandate this stuff from state licensing boards, I see a good case for a business here.
 
I have not encounter this, and I am licensed in 5 states-4 of which i don't actually live, obviously.

How would this even work? How do I know Dr. X/Group X would even be alive/competent/functioning when i die? What's the back-up there? And if I did, how do I know they would able to treat/accept/see a hypothetical flood of varied psychiatric patients that he/she knows nothing about? They just have to "agree" years before hand? Can these patients pay this person? Who would ever agree to sign something like this from another practitioner? I wouldn't! I thought this what the community mental health system in this country was for?
It’s not for the professional designated in your professional will to continue treating your patients, it’s identifying the professional who will be responsible for managing your patient files upon your death - notifiying current patients of your death, providing them with referrals to other providers, maintaining and/or closing the chart, etc.
 
When it is relevant to the treatment, I process termination issues in treatment so clients are ready for the relationship to end even if it is because of my own demise. As far as drafting a professional will and having some plan prepared for that, sounds like it could make some sense, but I'm still just trying to make ends meet here and one more task that doesn't lead to revenue in any way is not helpful.
There are a million details to take care of when starting up a business and a lot of things are difficult for a small business to do. As the billing manager, HR manager, marketing and sales manager, office handyman, and the primary income generator; I'll get to the will thing when it fits into my schedule.
 
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