Cash practice in addition to other practice?

[eaglepsych]

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Hello colleagues,

Question: in which cases is it ok to have a side cash practice. For instance, I know faculty at universities can do this, are these presumably all clinicians that only see inpts at this university setting?

What about va's, fqhc'c, etc. if one is employed at one of these can they have a cash practice on the side?

If someone takes insurance in one county or state, is cash practice allowable in different county or state?

If anyone has answers or resources willing to share would def appreciate it. Thanks!

 

[TexasPhysician]

That is a very complicated question. Many faculty actually can't have a private practice.

 

[billypilgrim37]

Not many rules of thumb. Depends almost entirely on your specific contract with your employer/how your boss interprets said contract.

 

[MacDonaldTriad]

This can be very complex. Often there is a non-compete clause in contracts because systems don’t want physicians draining away paying customers. Kaiser out right owns you 100%, but tends to reward accordingly. Universities often encourage on the side cash work, but they take a chunk of your billing. Steady pay checks are nice, but they come at some cost in flexibility. These are well worth considering when you compare salaries and job options.

 

[vistaril]

Hello colleagues,

Question: in which cases is it ok to have a side cash practice. For instance, I know faculty at universities can do this, are these presumably all clinicians that only see inpts at this university setting?

What about va's, fqhc'c, etc. if one is employed at one of these can they have a cash practice on the side?

If someone takes insurance in one county or state, is cash practice allowable in different county or state?

If anyone has answers or resources willing to share would def appreciate it. Thanks!

A lot of academic jobs aren't going to let you have your own pp.....after all, many/most academic jobs are going to have some outpt duties. Why would they want you billing for outpts separately when you are supposed to be giving them some outpt time as well?

But as others have pointed out, there are some exceptions and some arrangements which can be worked out.

 

[twright]

Hello colleagues,

Question: in which cases is it ok to have a side cash practice. For instance, I know faculty at universities can do this, are these presumably all clinicians that only see inpts at this university setting?

What about va's, fqhc'c, etc. if one is employed at one of these can they have a cash practice on the side?

If someone takes insurance in one county or state, is cash practice allowable in different county or state?

If anyone has answers or resources willing to share would def appreciate it. Thanks!

Basically that's the deal the department makes in order to attract/retain faculty: the university pays your overhead, you get to use it for your private practice, and you rebate the department a % of your fees. When the difference between private practice and academic faculty salaries is that large, the prestige of the university faculty appointment just isn't enough sometimes.

Many of the faculty where I trained had a private practice. (In fact, a common complaint of the junior residents on their inpatient and consult rotations was that the faculty were often nowhere to be found during the day. After morning rounds, basically they would disappear off to their offices to see their private pay patients.)

 

[eaglepsych]

Thank you all for your thoughts. To clarify, if there is no non-compete clause, do the insurance companies allow a provider to accept their insurance a one gig (say a university or a fqhc, etc), and not accept their insurance (aka cash only) in a different setting, county, or state?

Thanks a lot!

 

[vistaril]

Basically that's the deal the department makes in order to attract/retain faculty: the university pays your overhead, you get to use it for your private practice, and you rebate the department a % of your fees. When the difference between private practice and academic faculty salaries is that large, the prestige of the university faculty appointment just isn't enough sometimes.

Many of the faculty where I trained had a private practice. (In fact, a common complaint of the junior residents on their inpatient and consult rotations was that the faculty were often nowhere to be found during the day. After morning rounds, basically they would disappear off to their offices to see their private pay patients.)

I would say in cases like that(where faculty are seeing private outpatients during the MIDDLE OF THE DAY in university hospital offices) that is an exceptional situation and those faculty had such leverage that they were able to work out a special arrangement. because applied largescale to academia, it makes no sense. We know that most academic psych depts have large outpt services, and that's obviously not going to be compatible with all the attendings seeing their own private pay patients during the same times in the same offices.

 

[atsai3]

I would say in cases like that(where faculty are seeing private outpatients during the MIDDLE OF THE DAY in university hospital offices) that is an exceptional situation and those faculty had such leverage that they were able to work out a special arrangement. because applied largescale to academia, it makes no sense. We know that most academic psych depts have large outpt services, and that's obviously not going to be compatible with all the attendings seeing their own private pay patients during the same times in the same offices.

twright's post makes sense to me. At our program there were no clinics staffed by attendings. Basically, if a patient came to the clinic, s/he was to be seen by (a) one of the attendings in a private practice clinic, or (b) one of the residents in the resident clinic (with supervision by an attending). There was no "attending clinic". (Of course, I could be remembering things wrong. It is not unreasonable to think that I have a totally warped understanding of how our institution was operated. I was only a resident.)

 

[vistaril]

twright's post makes sense to me. At our program there were no clinics staffed by attendings. Basically, if a patient came to the clinic, s/he was to be seen by (a) one of the attendings in a private practice clinic, or (b) one of the residents in the resident clinic (with supervision by an attending). There was no "attending clinic". (Of course, I could be remembering things wrong. It is not unreasonable to think that I have a totally warped understanding of how our institution was operated. I was only a resident.)

I've only been at two institutions before(as med student and resident), and in both attendings saw pts that were theirs, but they weren't privately billing.


It makes absolutely no sense why a department would pay someone at a full salaried level(presumably based on 40 hrs/week) and let them be billing for their own private patients in their clinics during the same hours that they are paying them for their salary. I'm sure there are cases where it happens(ie if someone is really wanted), but I don't think this is common. More common would be arrangements where they could see pts after hours for a percentage.

For salaried academic psychiatrists, there is still an incentive to make your schedule as full as possible(or as needed) because to get paid you have to meet so many rvu's(or however credit is given..whether collections or billings). And in many cases if someone goes over their quota then a bonus structure may come into play, so in a way the person is seeing their own patients.

Again people, whatever scenario you are working in(except maybe a VA) nobody is really 'salaried' in medicine in any real sense. Your money comes from somewhere. If you're an inpatient salaried doc it comes from your inpatient billing codes for example. it doesn't just fall out of the sky into your lap.

 

[billypilgrim37]

It makes absolutely no sense why a department would pay someone at a full salaried level(presumably based on 40 hrs/week) and let them be billing for their own private patients in their clinics during the same hours that they are paying them for their salary. I'm sure there are cases where it happens(ie if someone is really wanted), but I don't think this is common. More common would be arrangements where they could see pts after hours for a percentage.

If X percentage of your time is "private practice," it makes perfect sense, i.e., 30% of your time (and thus your salary) comes from direct billing with a cut taken out. It's not necessarily double dipping. It's just dipping.

 

[michaelrack]

I've only been at two institutions before(as med student and resident), and in both attendings saw pts that were theirs, but they weren't privately billing.


It makes absolutely no sense why a department would pay someone at a full salaried level(presumably based on 40 hrs/week) and let them be billing for their own private patients in their clinics during the same hours that they are paying them for their salary. I'm sure there are cases where it happens(ie if someone is really wanted), but I don't think this is common. More common would be arrangements where they could see pts after hours for a percentage.

For salaried academic psychiatrists, there is still an incentive to make your schedule as full as possible(or as needed) because to get paid you have to meet so many rvu's(or however credit is given..whether collections or billings). And in many cases if someone goes over their quota then a bonus structure may come into play, so in a way the person is seeing their own patients.

Again people, whatever scenario you are working in(except maybe a VA) nobody is really 'salaried' in medicine in any real sense. Your money comes from somewhere. If you're an inpatient salaried doc it comes from your inpatient billing codes for example. it doesn't just fall out of the sky into your lap.

agree with twright and others, and disagree with vistaril. Academic salary is really complex. The base salary is low (it was in the 70's K range when I was an asst prof), and was provided by the medical school where I was at. This was often supplemented by directorship fees (in psychiatry, being medical director of a ward or service) paid by the dept or hospital. Researchers sometimes get $ from grants. We were expected to work a certain number of hours in the faculty group practice and got a % of our collections.

 

[vistaril]

agree with twright and others, and disagree with vistaril. Academic salary is really complex. The base salary is low (it was in the 70's K range when I was an asst prof), and was provided by the medical school where I was at. This was often supplemented by directorship fees (in psychiatry, being medical director of a ward or service) paid by the dept or hospital. Researchers sometimes get $ from grants. We were expected to work a certain number of hours in the faculty group practice and got a % of our collections.

but my point was that such a setup isn't a lot different than what I am talking about.

how is 'working a certain number of hours in the faculty group practice' and getting a % of collections any different than having a salary of 180k divided along a 1/5(teaching /med school), 1/5 research, 1/5 inpt, 2/5 outpt ratio and having to meet so many rvu's(or collections) as part of the 2/5 outpt ratio in your outpt clinic? It's all the sorta the same thing.

 

[michaelrack]

but my point was that such a setup isn't a lot different than what I am talking about.

how is 'working a certain number of hours in the faculty group practice' and getting a % of collections any different than having a salary of 180k divided along a 1/5(teaching /med school), 1/5 research, 1/5 inpt, 2/5 outpt ratio and having to meet so many rvu's(or collections) as part of the 2/5 outpt ratio in your outpt clinic? It's all the sorta the same thing.

You are right, it isn't a lot different than what you are talking about except: "More common would be arrangements where they could see pts after hours for a percentage. "
Seeing patients during regular hours is more common, although I have seen some faculty do early evening hours.

 

[billypilgrim37]

And for example next year, I'm 70% inpatient and 30% other things. The other things happen Tuesday and Thursday afternoons and Wednesday evenings. If I want to see private patients during the day Monday, Wednesday, and Friday, as long as it doesn't "meaningfully conflict with my primary responsibilities," which it never really would, then I can knock myself out and it's all direct billing with a cut taken out. Otherwise during those times I'd be doing teaching and coordination of care, each of which I can do at other times just as easily. Now, I probably won't do a lot of private practice, because part of the point of the job I took was that I'd have time for teaching and writing and other academic things that most people abhor, but that's just me.