Cash Private Practice Marketing

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F0nzie

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I've been thinking about starting a cash private practice on the side after residency to supplement my primary income and add diversity to my work and also try something new and exciting without having to deal with the administrative hassles and significant overhead required in working with managed care.

However, I'm still trying to figure out the logistics of how a prospective patient would find me to schedule an appointment. If I could fill a private outpatient clinic 2 Saturday's per month (16 hours) to supplement my full-time income I'd be satisfied. But even 16 hours seems like a lot of hours to fill without the almighty insurance companies funneling patients my way.

Despite the high demand for psychiatrists, there seems to be less % of physicians private practice than there were several years ago. It also seems to me that many private practice psychiatrists are succumbing to accepting insurance despite their efforts to transition away. I'm sure the economy has something to do with this.

So anyways, I figured I'd start this thread for myself and residents who get little to no business experience during residency. There are some of us who want to go rogue and ditch managed care completely- I am highly skeptical this is a viable model for the average psychiatrist.

Assuming you are situated in an upper-middle class+ area. Here's a list I came up with for getting a prospective patient for a cash practice:
1. Create an internet presence (Google business, website, etc), however I can't imagine many people being like "oh boy let me find a psychiatrist that's out of network because I don't want to wait 1-3 months for an appointment... let me check google" unless they were pilots or doctors that need more privacy or rich trendy people in NYC that know of this loophole. Despite being in the information technology age I don't think very many people are looking up doctors on the internet unless it's a plastic surgeon or an anti-aging doctor. Maybe I'm overly biased here.
2. Yellow pages?
3. Contact nearby primary care providers and let them know you're starting a private practice (how exactly to contact them I'm not sure...fax? fliers? take them out to lunch?). To me this seems like the most effective strategy, but I could be wrong.
4. Write an article in the local newspaper
5. Advertise in the local newspaper
6. Public speaking (I'm not even sure where to begin or what avenues to take. ideas?)
7. Get on a physician directory
8. Hand out fliers (what are some good places to put fliers?)
9 Sell yourself on Craigslist (sinking too low?) :)

I'm not deluding myself into thinking that people are going to magically call my office for an appointment just because I graduated residency and my name is in the yellow pages. I also can't conceptualize how starting a private practice by initially accepting insurance, filling, then d/cing insurance panels and accepting cash only as a sustainable long-term model- but maybe I'm not understanding a fundamental aspect of this maneuver. Reputation and word of mouth are not in the equation at this point, but I'm not looking for a fortune- just a small practice on the side that is viable with sustainable growth. Some advice and perspective appreciated!

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I'm building my cash private practice (I have a separate clinic dayjob right now), and I've worked a bit to build an internet presence (got on a therapist directory, cultivated some other means), and every patient I see has come from referrals, as a result of networking. I go to events at various medical and mental health societies, pass my card out a lot, talk to a lot of people. And even then it has taken months to really start getting referrals. But they're coming. Slowly. Being a psychiatrist that does therapy helps, because other psychiatrists like to have someone to send pt's do who does everything, and therapists are always looking for ppl to do med mgmt. So I get referrals from both sides. The online presence has led to Zero pt's so far.

Since you're opening up in the town you're training in, I'd solicit your mentors, colleagues, and consider (cautiously) mentioning it to your other patients. Patients that like you will refer their friends to you.
 
Since you're opening up in the town you're training in, I'd solicit your mentors, colleagues, and consider (cautiously) mentioning it to your other patients. Patients that like you will refer their friends to you.
Yeah, I'd tread real, real carefully on that patch of thin ice...
 
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1. The yellow pages is a horrid investment for the vast majority of businesses, just skip it all together. The same can be said for newspapers. And for no extra charge, if you use them once...they will call you endlessly to get you to re-up.

2. Network with GPs/FPs, as a few good referral contacts are worth their weight in gold.

3. Do NOT solicit where you work. At best you may step on some toes, at worst you will piss off your mentors/other attendings and possibility violate internal policy, which can be grounds for termination.

4. Make a business plan, and use it. If you do not know how to, go buy some books and read up. The majority of failed practices are due to poor planning and not for a lack of work.
 
The online presence has led to Zero pt's so far.

This is KEY. I have done quite a bit of investigation and research into this matter. The fact you are practicing in L.A, the 2nd largest city in the US really sheds some light here for me. My hypothesis regarding this is:

1. Despite the shortage of psychiatrists, the shortage is not significant to the point where people are utilizing search engines to look up psychiatrists. Thus, creating an online presence in psychiatry is probably not as useful as it may otherwise be for other businesses outside of the medical system.

2. Most patients seeking psychiatrists come from referrals. Basically doctors telling patients "I think you should see a psychiatrist...here is a list", not individuals thinking "I feel depressed, I need to see a mental health provider... let me open up Google and find one". Or if they do self-refer, they're like "let me call my insurance company".

3. Networking with other physicians seems like the most effective way to to build a cash private practice. I would imagine that at least 3/4's of the referrals will be unable to pay cash, unless your referrers specifically weed them out for you by informing them you don't accept insurance.

I go to events at various medical and mental health societies, pass my card out a lot, talk to a lot of people.

That's a fantastic idea and quite the dedication. You're really thinking out of the box- I need to do more of this myself.

What I need to figure out for myself is my willingness to take on this type of financial risk and investment of time. I am approximating a conservative 10k per year in overhead (rent, part-time malpractice insurance, office supplies), with the potential to make around 40k per year by working 16 hours a month and coming out ahead with 30k in profits....while having to promote myself on the side. I don't even want to calculate what that's going to be after taxes after adding it to my primary income. DAMN this doesn't seem easy! :( I'm not ready to give up though! * starts deep breathing, progressive muscle relaxation, fixes cognitive distortions* Ok I'm better.

Make a business plan, and use it.

Working on it!
 
As a cash practitioner, you will need to be as good or better outside of the office as you are in the office. When I was a corp. consultant my mentor taught me to treat a referral like you would a friend's family member. You want to provide good service to everyone, but you really want to make sure to do it when the person comes in because of another provider's recommendation. In this context it means providing services that make the patient want to thank their GP/FP/etc. for introducing them to you. It can take as few as one of those experiences to cement your name high up on a provider's referral list. If you handle it right, you will start to see 2nd and 3rd degree referrals (patients coming from providers that found you through talking with colleagues in different offices). The most profitable practices are those who don't have to spend extra time & money on promoting themselves. Simple, right? :D
 
As a cash practitioner, you will need to be as good or better outside of the office as you are in the office. When I was a corp. consultant my mentor taught me to treat a referral like you would a friend's family member. You want to provide good service to everyone, but you really want to make sure to do it when the person comes in because of another provider's recommendation. In this context it means providing services that make the patient want to thank their GP/FP/etc. for introducing them to you. It can take as few as one of those experiences to cement your name high up on a provider's referral list. If you handle it right, you will start to see 2nd and 3rd degree referrals (patients coming from providers that found you through talking with colleagues in different offices). The most profitable practices are those who don't have to spend extra time & money on promoting themselves. Simple, right? :D

Old joke -- the only emergency in [outpatient] psychiatry is a referral.
 
I have a page on Psychology Today. 90% of my referrals come from people who found me on there. I think it helps to have special qualifications, eg graduating from a top residency, specialized training (eg addiction, analytic training, sleep), publications. In this day and age, the first thing people tend to do when they need to solve a problem is go online.
 
#1 by and far is still networking with PCP's and other mental health providers.

As the generation dynamics start to shift with baby boomers dying off and millenials/Gen X moving up, there will be a greater reliance upon internet searching. Online presence should not be neglected in anticipation of this demographic change. Furthermore the younger generations will also be the ones scheduling the appointments for the older generations in just 10-15 years time, further reason to not discount internet presence. Its just not the mainstay, yet.

Anticipate in a few years once the damage becomes apparent from Obamacare that there will be a more solidily defined two tiered system. This is opposite of what Obamacare is trying to create, but will be the end result. People seeking to flee the uncaring, brief visits, sub-par treatment, mid-level driven grind of the emerging healthcare machine will come knocking on outpatient physicians doors. Those best suited for this new future are PCPs, psych, peds (maybe), derm, solo practice OBGYN (i.e. guarantee they will be the one to deliver their baby not their partner covering them on vacation), and an extreme minority of GS/Plastics/cardiology. The current surigical specialization mentality and financial foundation of the system (procedures) will come crumbling down and thinking specialties will again be superior to proceduralists in all facets (med student choice, prestige, income, lifestyle, etc.). The ACOs will be the impetus behind this change, as it is merely a thinnly covered veil of capitation. Capitation encourages less, especially less procedures...

I will be opening my own practice after residency.

I am in the process of opening my own practice in residency, too.
 
#1 by and far is still networking with PCP's and other mental health providers.

As the generation dynamics start to shift with baby boomers dying off and millenials/Gen X moving up, there will be a greater reliance upon internet searching. Online presence should not be neglected in anticipation of this demographic change. Furthermore the younger generations will also be the ones scheduling the appointments for the older generations in just 10-15 years time, further reason to not discount internet presence. Its just not the mainstay, yet.

Anticipate in a few years once the damage becomes apparent from Obamacare that there will be a more solidily defined two tiered system. This is opposite of what Obamacare is trying to create, but will be the end result. People seeking to flee the uncaring, brief visits, sub-par treatment, mid-level driven grind of the emerging healthcare machine will come knocking on outpatient physicians doors. Those best suited for this new future are PCPs, psych, peds (maybe), derm, solo practice OBGYN (i.e. guarantee they will be the one to deliver their baby not their partner covering them on vacation), and an extreme minority of GS/Plastics/cardiology. The current surigical specialization mentality and financial foundation of the system (procedures) will come crumbling down and thinking specialties will again be superior to proceduralists in all facets (med student choice, prestige, income, lifestyle, etc.). The ACOs will be the impetus behind this change, as it is merely a thinnly covered veil of capitation. Capitation encourages less, especially less procedures...

I will be opening my own practice after residency.

I am in the process of opening my own practice in residency, too.

I would add that there is a Large body of older psychiatrists that do psychotherapy that are about to retire as well. This is a great opportunity to be able to inherit groups of patients that are used to seeing a psychiatrist for meds and therapy. So networking with older psychiatrists is a huge plus.
 
I have a page on Psychology Today. 90% of my referrals come from people who found me on there.

It's interesting you mention that as I've seen several psychiatrists register on the Psychology Today site and utilize their logo. It's good to know it seems to hold some promise given your success. I'm presuming you're offering psychotherapy?
 
I am in the process of opening my own practice in residency, too.

This is cool and reeks pure ambition. This is like moonlighting except you're hiring yourself. Haha! How are you going to deal with your program directors and attendings looking at you with a jaundiced eye? Does it not matter since you're graduating in 6 months anyways?
 
A colleague of mine has his practice in a medical office building attached to a hospital. Yes, due to it being in a hospital the rent is higher, but he gets pretty much every single psychiatric referral for outpatient first in that entire hospital system. He is inundated.

And yes the rent is higher but he gets tons of perks because of the hospital. E.g. a pharmacy attached to the building, security (definitely a plus in psychiatry), the hospital manages the maintenance, medical colleagues literally a few rooms away, a lab right there, and he can still be attached to the hospital culture if he wants (e.g. having colleagues in the psychiatric dept, going to grandrounds, wasting time having a drink with a colleage in the doctor's lounge, while also being able to stay away from it too if that's his whim of the day.

IMHO his higher rent is well worth it.
 
A colleague of mine has his practice in a medical office building attached to a hospital. Yes, due to it being in a hospital the rent is higher, but he gets pretty much every single psychiatric referral for outpatient first in that entire hospital system. He is inundated.

And yes the rent is higher but he gets tons of perks because of the hospital. E.g. a pharmacy attached to the building, security (definitely a plus in psychiatry), the hospital manages the maintenance, medical colleagues literally a few rooms away, a lab right there, and he can still be attached to the hospital culture if he wants (e.g. having colleagues in the psychiatric dept, going to grandrounds, wasting time having a drink with a colleage in the doctor's lounge, while also being able to stay away from it too if that's his whim of the day.

IMHO his higher rent is well worth it.

Wow, that is a great setup.
 
Considering those perks, the rent might not really be all that high when you think about it.
 
The guy asked me to take over his practice. I'm still thinking of doing it. My own doctor's parking space, the perks I mentioned, my patients being able to pick up meds in the same building, suicidal patients being able to be sent right to the ER in the same location, being able to perform Suboxone inductions without the patient having to drive to a pharmacy and coming back.....

And I know it's psychological, but when I walk into his office, I just feel more credible with it being in an office attached to a hospital vs. an office park like my current setting.
 
This is cool and reeks pure ambition. This is like moonlighting except you're hiring yourself. Haha! How are you going to deal with your program directors and attendings looking at you with a jaundiced eye? Does it not matter since you're graduating in 6 months anyways?

All the higher ups are okay with this. They were the first people I asked. I'm a resident first and still a few years from finishing.
 
I've been entirely cash only for several years. My biggest referral sources are psychologists/other therapists, primary care providers, pediatricians, ob/gyns, and attorneys. I see C/A also so that makes the demand higher and several elementary and high school counselors send students regularly. I also have a good relationship with the local university's counseling center and they send many folks my way.

Have an online presence of some kind also. It doesn't have to be anything fancy, just some way for potential referrals to find you online to learn more about you.
 
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