Compensation structure

[clausewitz2]

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Yet another request for the wisdom of the hive mind. I'm still weighing job options for next year, and one private practice opportunity is very compelling from a clinical interest point of view. The people I would be working with are solid and pretty passionate. They have not, however, had a psychiatrist to date and so are hazy on practicalities of billing and compensation structures from the medical side of things.

At present they are talking about a 70/30 split; I am pretty sure they mean this split to be based on collections rather than billable or billed codes but we haven't pinned down that detail. I think there is a lot of room to grow a solid panel here and my relatively conservative projections suggest my financial needs will be met, but of course projections are not actually the same as cash.

For various reasons and fixed costs I can't cut I need to have some kind of reliable income for the first year or so I am out practicing, but it needn't be all of my compensation. While I will probably fill relatively quickly I don't know how fast that will actually happen and right now they probably don't have enough active clients to give me more than a couple days per week, so asking for the minimum of what I am going to need all as salary is not fiscally sustainable for them.

They are going to the lengths of actually setting up an employer health insurance plan for the first time after I mentioned this would be a requirement of mine (due to some of those fixed costs) so I think they might be willing to play ball but I also don't want to push too hard. The thought occured to me of suggesting something like a smaller base salary with payment based on productivity beyond a certain point, but I am open to all suggestions. How would you guys do it?

Aside: 'just do it all as a fee split, 1099 is best 99" etc. is not an option so don't waste your digital muscular effort. Viz. health insurance.

 

[Merely]

How much money are we talking in any of these options

 

[Sushirolls]

Pin down the 70/30 as collections, that's very important, and then the details of you having access to see the books to confirm that you are getting 70/30.

What's the real benefit for you to work with them? Is it the collegiality of these psychologists? Is it the convenience of having people around to be able to socialize with in between patients? Is it location? Is it the back office admin billing side of things? Etc. What is the WHY of working with them? Once you have answered that question, you potentially monetize that and see if its comparable to the 30 you'll be giving up.

An established psychology group doesn't have many new patients. For the most part they will be relatively full, and most of their patients who need meds will have already been seen by another person, or simply don't need meds. So the volume of their new patients will be low, and of those, only a fraction need medication. I don't anticipate you filling that fast. If you are with a primary care group or a Big Box shop, then yes, those PCPs will definitely fill you in 3 months.

If you need a guarantee salary, and you already know they can't float that and your demands for health insurance, sounds like this might not be viable?

An alternative payment structure is a loan model for salary guarantee. Let's say you want $1000/month guaranteed. You generate in collections month 1-$180, 2-$220, 3-$790, 4-$1250, 5-$1800, 6-$2300. They would loan you money to get you your salary guarantee of $1000, to look like 1-$820, 2-$780, 3-$110, and then in month 4 you will start the process of paying back the previous loaned money [820+780+110=$1710], which means you only take home in month 4 $1000, because that extra $250 goes towards paying off the loan of $1710 you accrued earlier [$1710-$250=$1460 debt]. After month 5 the extra $800 has reduced your debt to $660. Month 6 you don't collect the full $2300, but $2300-660=$1640. Now month 7 onward you get what you earned with no deductions. I hope this makes sense?

To answer your last question of how I would do it, I wouldn't do it. At most I'd request to sublease from them, and you'll still likely get the same rate of referrals from them as if you were employed by them. This way, you can control the rest of your overhead, billing, notes, etc. Or if they are paneled with bad insurance XYZ, you chose to not be paneled with that insurance. Also if you discharged a patient, its more difficult when you are part of the group, then the rest of the group will get their say on discharge process. Or if you want your patients seen by Psychologist Sigmund, but not Psychologist Freud, you can be that brass because, well, you aren't an employee and don't have to worry about those group politics.

 

[splik]

you would need to ask for a salary to begin with, because if it is entirely done on collections etc (it not reasonable to ask for % of billings in this setting), it will be many months before you see a paycheck (depending on how they do their billing). I have some pts I saw in August and still have not received the money from the insurance company from (this is more unusual but there is definitely a lag). Payors are variable, and then there may be non-coverage, or getting portions of fees from patients, some of which will only be billed once they insurance company has reviewed etc. So they would really need to front you the money based on expected compensation/productivity even if you ultimately would be on a 70/30 model. For that you should be getting health insurance, malpractice, possibly disability insurance, CME, vacation and CME/professional leave, EMR if they use one, and they will do all your advertising/referrals and billing for you and provision of coverage for when you are away etc. Ideally someone will be answering calls from pts and able to help with prior auths, refills etc etc.

Also bear in mind if you are the sole psychiatrist for this practice, the reimbursement is likely to be much less than for a group practice or a larger health care organization as there is no capacity/incentive for insurance companies to negotiate. Personally I would not want to work for a psychology practice, I cannot see any positives to this, only negatives.

 

[NickNaylor]

Many of the private practice shops in our area work on a model where compensation is guaranteed for a set amount of time - usually a year or two - before transitioning gradually to a full productivity-based compensation model. As an example, years 1-2 might be a guaranteed salary, year 3 might be 80% guaranteed (i.e., the practice pays 80% of what they paid you in years 1-2) and 20% compensation, year 4 might be 50/50, and year 5 might be 90/10. I made those figures up, but something like this isn't atypical. The situation would be a bit different for you since it sounds like there would be some degree of guaranteed income over the long-term.

I would try to negotiate for guaranteed income for a set amount of time - maybe somewhere between 6-18 months - so that you can get a sense of what the volume is and how it's growing. That way you can be prepared if your panel doesn't grow as you and the other members of the group seem to expect that it will.

 

[TexasPhysician]

70/30 is good for a busy medical practice that can fill you quickly. It would be low from a psychology practice. First, they won’t help fill your practice by much. In fact, you may greatly help them.

 

[dl2dp2]

Sushirolls and TexasPhysician are 100% correct.

I would ask a fixed $ per hour of work--it would vastly simplify things to start. Then buy PPO health insurance off the private market. If you ask for health insurance, they'll just take a chunk off your revenue generated anyway, and unless you work a very large organization, there's very little saving on that front.

In the meanwhile, if you want to start a practice, start a practice, or join an MD-based practice. There's zero upside in being employed by a psychologist driven practice, unless they pay you equity from day 1. This is also why this arrangement is uncommon. Medical directors of PhD driven practices typically have ownership stakes. Especially if you take insurance, referrals will go the way of you --> PhDs, not the other way around.

In my experience, many excellent clinicians, especially psychologists, are terrible with businesses. You need to be very careful. In the broadest of generalities, MDs are vastly superior to PhDs in practice management. You might make mistakes, but I've never heard of MDs get stuck in insane circumstances as I have of PhDs, and this is given psychiatrists are probably some of the worst MDs in biz.

 

[clausewitz2]

Pin down the 70/30 as collections, that's very important, and then the details of you having access to see the books to confirm that you are getting 70/30.

What's the real benefit for you to work with them? Is it the collegiality of these psychologists? Is it the convenience of having people around to be able to socialize with in between patients? Is it location? Is it the back office admin billing side of things? Etc. What is the WHY of working with them? Once you have answered that question, you potentially monetize that and see if its comparable to the 30 you'll be giving up.

An established psychology group doesn't have many new patients. For the most part they will be relatively full, and most of their patients who need meds will have already been seen by another person, or simply don't need meds. So the volume of their new patients will be low, and of those, only a fraction need medication. I don't anticipate you filling that fast. If you are with a primary care group or a Big Box shop, then yes, those PCPs will definitely fill you in 3 months.

If you need a guarantee salary, and you already know they can't float that and your demands for health insurance, sounds like this might not be viable?

An alternative payment structure is a loan model for salary guarantee. Let's say you want $1000/month guaranteed. You generate in collections month 1-$180, 2-$220, 3-$790, 4-$1250, 5-$1800, 6-$2300. They would loan you money to get you your salary guarantee of $1000, to look like 1-$820, 2-$780, 3-$110, and then in month 4 you will start the process of paying back the previous loaned money [820+780+110=$1710], which means you only take home in month 4 $1000, because that extra $250 goes towards paying off the loan of $1710 you accrued earlier [$1710-$250=$1460 debt]. After month 5 the extra $800 has reduced your debt to $660. Month 6 you don't collect the full $2300, but $2300-660=$1640. Now month 7 onward you get what you earned with no deductions. I hope this makes sense?

To answer your last question of how I would do it, I wouldn't do it. At most I'd request to sublease from them, and you'll still likely get the same rate of referrals from them as if you were employed by them. This way, you can control the rest of your overhead, billing, notes, etc. Or if they are paneled with bad insurance XYZ, you chose to not be paneled with that insurance. Also if you discharged a patient, its more difficult when you are part of the group, then the rest of the group will get their say on discharge process. Or if you want your patients seen by Psychologist Sigmund, but not Psychologist Freud, you can be that brass because, well, you aren't an employee and don't have to worry about those group politics.

Appreciate the detailed response, point well taken about verifying revenues. In terms of why, it's a combination of a very specific population (being a bit cagey to reduce chance of being doxxed), collegiality, working in a team environment, demonstrable dedication to scrupulously evidence-based practice, available clerical support, and making use of a fairly aggressive marketing presence. I also do not have the time or energy to hang a shingle right now due to other commitments. I will have a think about what this cashes out at for me.

They are expanding rapidly at the moment and in addition to current client base of ~250 they have a 100+ waiting list. They are hiring multiple therapists in the next few months and are settling on details for their fourth office. Will start running specialized groups imminently so another potential source. Good point about the rate of new patients being slower than at a medical practice, though.

I think I understand the loan proposal you outline. They have also already asked about taking on medical director role as they expand their offerings and meet the regulatory requirements to allow them to have psych interns and qualify as a clinic. Basically I think this is also an opportunity to get on on the ground floor and build something, which I admit is also attractive.

 

[clausewitz2]

you would need to ask for a salary to begin with, because if it is entirely done on collections etc (it not reasonable to ask for % of billings in this setting), it will be many months before you see a paycheck (depending on how they do their billing). I have some pts I saw in August and still have not received the money from the insurance company from (this is more unusual but there is definitely a lag). Payors are variable, and then there may be non-coverage, or getting portions of fees from patients, some of which will only be billed once they insurance company has reviewed etc. So they would really need to front you the money based on expected compensation/productivity even if you ultimately would be on a 70/30 model. For that you should be getting health insurance, malpractice, possibly disability insurance, CME, vacation and CME/professional leave, EMR if they use one, and they will do all your advertising/referrals and billing for you and provision of coverage for when you are away etc. Ideally someone will be answering calls from pts and able to help with prior auths, refills etc etc.

Also bear in mind if you are the sole psychiatrist for this practice, the reimbursement is likely to be much less than for a group practice or a larger health care organization as there is no capacity/incentive for insurance companies to negotiate. Personally I would not want to work for a psychology practice, I cannot see any positives to this, only negatives.

Yes, there will be support in place for refills, prior auths, etc. Even the solo rates for private practice insurance psychiatrists in this area are generous enough that a lower rate of reimbursement v. a bigger practice is acceptable for me right now. Absolutely maximizing the money is not at this very moment my priority. Appreciate the advice re: insurance payment timelines and making sure malpractice, CME etc is thrown in.

 

[clausewitz2]

Many of the private practice shops in our area work on a model where compensation is guaranteed for a set amount of time - usually a year or two - before transitioning gradually to a full productivity-based compensation model. As an example, years 1-2 might be a guaranteed salary, year 3 might be 80% guaranteed (i.e., the practice pays 80% of what they paid you in years 1-2) and 20% compensation, year 4 might be 50/50, and year 5 might be 90/10. I made those figures up, but something like this isn't atypical. The situation would be a bit different for you since it sounds like there would be some degree of guaranteed income over the long-term.

I would try to negotiate for guaranteed income for a set amount of time - maybe somewhere between 6-18 months - so that you can get a sense of what the volume is and how it's growing. That way you can be prepared if your panel doesn't grow as you and the other members of the group seem to expect that it will.

My thoughts ran along these lines as well. Glad to hear that this is not actually insane, as it seems to be an unusual arrangement in this neck of the woods. I will raise it as a possibility.

 

[clausewitz2]

Sushirolls and TexasPhysician are 100% correct.

I would ask a fixed $ per hour of work--it would vastly simplify things to start. Then buy PPO health insurance off the private market. If you ask for health insurance, they'll just take a chunk off your revenue generated anyway, and unless you work a very large organization, there's very little saving on that front.

In the meanwhile, if you want to start a practice, start a practice, or join an MD-based practice. There's zero upside in being employed by a psychologist driven practice, unless they pay you equity from day 1. This is also why this arrangement is uncommon. Medical directors of PhD driven practices typically have ownership stakes. Especially if you take insurance, referrals will go the way of you --> PhDs, not the other way around.

In my experience, many excellent clinicians, especially psychologists, are terrible with businesses. You need to be very careful. In the broadest of generalities, MDs are vastly superior to PhDs in practice management. You might make mistakes, but I've never heard of MDs get stuck in insane circumstances as I have of PhDs, and this is given psychiatrists are probably some of the worst MDs in biz.

Fixed hourly rate is a good idea - I actually have a standing offer from somewhere else in a similar-ish setting for just that so have a good springboard for negotiations. Unfortunately for various reasons the health insurance issue is not about savings and the exchanges are not a viable option. Can't really get into details, so you will have to take my word on that. It hugely complicates the situation obviously.

I will definitely push for equity when the medical director discussion comes up as they seem to think it will soon.

 

[dl2dp2]

Fixed hourly rate is a good idea - I actually have a standing offer from somewhere else in a similar-ish setting for just that so have a good springboard for negotiations. Unfortunately for various reasons the health insurance issue is not about savings and the exchanges are not a viable option. Can't really get into details, so you will have to take my word on that. It hugely complicates the situation obviously.

I will definitely push for equity when the medical director discussion comes up as they seem to think it will soon.

No, you are confused. There is the [Obamacare] exchange, and then there is the private market [off exchange]. You need to get a dealer. Generally, you can get very high-quality PPO medical insurance through a private market dealer. It costs anywhere between 15k-25k a year for a family plan (maybe), sometimes cheaper for an individual. Secondarily, there's no guarantee that the plan that your practice buys for you will cover the services you need, especially if it's a practice that has not had experience purchasing insurance products for their employees.

I suspect neither Sushirolls or TexasPhysician has an ACA plan. Generally, people in my area who are in solo practice do NOT have ACA plans.

 

[clausewitz2]

No, you are confused. There is the [Obamacare] exchange, and then there is the private market [off exchange]. You need to get a dealer. Generally, you can get very high-quality PPO medical insurance through a private market dealer. It costs anywhere between 15k-25k a year for a family plan (maybe), sometimes cheaper for an individual. Secondarily, there's no guarantee that the plan that your practice buys for you will cover the services you need, especially if it's a practice that has not had experience purchasing insurance products for their employees.

I suspect neither Sushirolls or TexasPhysician has an ACA plan. Generally, people in my area who are in solo practice do NOT have ACA plans.

Sorry, no, should have been clearer. Off-exchange private is even less of an option and not mainly because of cost. I know precisely what plan the practice is purchasing because they sent me the policy documents to make sure I was good with it.

As I said, please believe me when I say a group-market plan is a sine qua non in my specific situation. I wish it weren't the case. My particular situation is unusual in this respect.

 

[FlowRate]

I'm not trying to get @clausewitz2 to divulge any additional info, but now I am very curious about private health insurance. Do private health ins plans outside of the ACA open enrollment plans (almost all HMOs) require medical underwriting/sending them your medical information? Edit: Reading more about it, looks like they also do not cover maternity or mental health?

 

[dl2dp2]

Okay, if you've investigated through a dealer. Maybe they got a great deal on a group market plan. In my experience, difference in cost between the two scenarios is fairly minimal. The practices just fold the cost into that "30% overhead". In any case, they can still pay you hourly as long as the numbers are totally "off", which would be seemingly more ideal for now, until you get a better sense of the practice, revenue stream, etc. Telepsych comapnies do this all the time--if you work X number of hours they'll give you benefits, but the hourly rates don't vary wether you get benefits or not.

 

[dl2dp2]

I'm not trying to get @clausewitz2 to divulge any additional info, but now I am very curious about private health insurance. Do private health ins plans outside of the ACA open enrollment plans (almost all HMOs) require medical underwriting/sending them your medical information? Edit: Reading more about it, looks like they also do not cover maternity or mental health?

Sometimes yes, sometimes no. Depends on the situation. The definition of "pre-existing condition" also varies.

If you need a lot of psychotherapy time (i.e. for psychoanalysis), typically you'll need a PPO plan with a lowish out of pocket max. This is pretty common in our field--esp. for people in private practice. Plenty of solo practitioners in my area were able to buy private off-exchange PPO plans that largely cover their personal psychoanalysis.

There are other similar scenarios, for example for fertility treatment. Some PPOs pay well with low out of pocket max. Others pay none at all. It depends on which off-exchange plans you have access to in your area. In some geographical areas, off-exchange plans don't exist that allow coverage for providers for services like fertility care. In other areas, due to competition, paying out of pocket for fertility care is often cheaper and faster than trying to go in-network.

That said, if they only get psychopharm, it might end up being cheaper if they buy catastrophic/ACA plans and just pay cash, since PPO plans are so expensive. OTOH, since plan costs are 100% deductible in a 1099 situation, depending on how much money you generate, it might end up making sense.

I.e. if you make 600g a year in practice, you spend 30g on medical insurance, that's actually only 15g post-tax. Meanwhile, if you buy ACA plans it'll have to be post-tax dollars. That said, bad ACA plans give you an HSA, which then can be used to pay pretax dollars. LOL these are not straightfoward calculations. These things complicate your math a lot. If you don't make much money, it's usually best to stick with group plans work for a large organization. If you can generate lots and lots of revenue, and especially in a high-income tax state, generally it's vastly better to do 1099 because over and above a revenue threshold, taxes kill you.

 

[finalpsychyear]

Sometimes yes, sometimes no. Depends on the situation. The definition of "pre-existing condition" also varies.

If you need a lot of psychotherapy time (i.e. for psychoanalysis), typically you'll need a PPO plan with a lowish out of pocket max. This is pretty common in our field--esp. for people in private practice. Plenty of solo practitioners in my area were able to buy private off-exchange PPO plans that largely cover their personal psychoanalysis.

There are other similar scenarios, for example for fertility treatment. Some PPOs pay well with low out of pocket max. Others pay none at all. It depends on which off-exchange plans you have access to in your area. In some geographical areas, off-exchange plans don't exist that allow coverage for providers for services like fertility care. In other areas, due to competition, paying out of pocket for fertility care is often cheaper and faster than trying to go in-network.

That said, if they only get psychopharm, it might end up being cheaper if they buy catastrophic/ACA plans and just pay cash, since PPO plans are so expensive. OTOH, since plan costs are 100% deductible in a 1099 situation, depending on how much money you generate, it might end up making sense.

I.e. if you make 600g a year in practice, you spend 30g on medical insurance, that's actually only 15g post-tax. Meanwhile, if you buy ACA plans it'll have to be post-tax dollars. That said, bad ACA plans give you an HSA, which then can be used to pay pretax dollars. LOL these are not straightfoward calculations. These things complicate your math a lot. If you don't make much money, it's usually best to stick with group plans work for a large organization. If you can generate lots and lots of revenue, and especially in a high-income tax state, generally it's vastly better to do 1099 because over and above a revenue threshold, taxes kill you.

Man i know so little about health insurance. I thought i was doing something smart when i got one this year that allows me to have an HSA but is obviously a HDHP (6750 ded then 100% coverage) that obviously I self fund as I am just a straight 1099 earner. Its private and rated as a top insurer in the state.

Hmm had i somehow done it through my business I could have gotten an even better plan? I pay 300 bucks a month for 1 person but i was paying 100 something last year when i kept doing short term monthly plans as I don't use health insurance and hope i never have to aside from preventative care services.

 

[clausewitz2]

Sometimes yes, sometimes no. Depends on the situation. The definition of "pre-existing condition" also varies.

If you need a lot of psychotherapy time (i.e. for psychoanalysis), typically you'll need a PPO plan with a lowish out of pocket max. This is pretty common in our field--esp. for people in private practice. Plenty of solo practitioners in my area were able to buy private off-exchange PPO plans that largely cover their personal psychoanalysis.

There are other similar scenarios, for example for fertility treatment. Some PPOs pay well with low out of pocket max. Others pay none at all. It depends on which off-exchange plans you have access to in your area. In some geographical areas, off-exchange plans don't exist that allow coverage for providers for services like fertility care. In other areas, due to competition, paying out of pocket for fertility care is often cheaper and faster than trying to go in-network.

That said, if they only get psychopharm, it might end up being cheaper if they buy catastrophic/ACA plans and just pay cash, since PPO plans are so expensive. OTOH, since plan costs are 100% deductible in a 1099 situation, depending on how much money you generate, it might end up making sense.

I.e. if you make 600g a year in practice, you spend 30g on medical insurance, that's actually only 15g post-tax. Meanwhile, if you buy ACA plans it'll have to be post-tax dollars. That said, bad ACA plans give you an HSA, which then can be used to pay pretax dollars. LOL these are not straightfoward calculations. These things complicate your math a lot. If you don't make much money, it's usually best to stick with group plans work for a large organization. If you can generate lots and lots of revenue, and especially in a high-income tax state, generally it's vastly better to do 1099 because over and above a revenue threshold, taxes kill you.

This is good to know. As I said not an issue of cost in this case.

Minor update: an agency with a federal grant is offering me 10 hours a week to work with my -other- main population of interest, and at a healthy flat hourly rate. Since this group practice only wants a 20 hour commitment for bennies and the ten hours would be a significant bump over my current salary all by itself I think I'm gonna do it. The inputs re how and what are reasonable payment structure asks will be extremely valuable!

 

[Sushirolls]

Appreciate the detailed response, point well taken about verifying revenues. In terms of why, it's a combination of a very specific population (being a bit cagey to reduce chance of being doxxed), collegiality, working in a team environment, demonstrable dedication to scrupulously evidence-based practice, available clerical support, and making use of a fairly aggressive marketing presence. I also do not have the time or energy to hang a shingle right now due to other commitments. I will have a think about what this cashes out at for me.

They are expanding rapidly at the moment and in addition to current client base of ~250 they have a 100+ waiting list. They are hiring multiple therapists in the next few months and are settling on details for their fourth office. Will start running specialized groups imminently so another potential source. Good point about the rate of new patients being slower than at a medical practice, though.

I think I understand the loan proposal you outline. They have also already asked about taking on medical director role as they expand their offerings and meet the regulatory requirements to allow them to have psych interns and qualify as a clinic. Basically I think this is also an opportunity to get on on the ground floor and build something, which I admit is also attractive.

This volume of theirs isn't that much...
A 35-40 hour per week clinical Psychiatrist emphasizing 30 minute med checks on a lower end will have a full practice with 400 patients. I have very little therapy patients, and projections for my style of practice with 30 min follow ups, and pushing out no further then 3 months, subtracting an average vacation allotment in that 3 month window, I could possible have an upper panel of 760 patients, but anticipate being the in the low 300's for for a 30hr clinical work week.

 

[Sushirolls]

ACA exchange is highly variable by region/location.
Some have more insurance companies, some less.
Some of those companies offer different plan levels.
Some of my patients coming in the office with exchange purchased plans are quite comprehensive with limited/no out of pocket costs, but others only cover a smaller fraction of the network negotiated rate.

 

[clausewitz2]

This volume of theirs isn't that much...
A 35-40 hour per week clinical Psychiatrist emphasizing 30 minute med checks on a lower end will have a full practice with 400 patients. I have very little therapy patients, and projections for my style of practice with 30 min follow ups, and pushing out no further then 3 months, subtracting an average vacation allotment in that 3 month window, I could possible have an upper panel of 760 patients, but anticipate being the in the low 300's for for a 30hr clinical work week.

Yup, part of why I am only putting in 20ish hours. Dynamics ate a bit different from a garden variety therapy practice, though - what they do is time-limited and while a need for medication will exist for most folks indefinitely they do actually graduate from therapy at a good clip. They might occasionally return to therapy from time to time but I fully anticipate eventually having more patients than their current census even without having to take in folks directly who have never engaged with them.

I was offered a CMHC gig taking over someone's 600 patient panel with 20 min follow ups ('you get 40 for new patients if they just got out of the hospital because you already have the h&p'), hard pass.

 

[Ironspy]

Yup, part of why I am only putting in 20ish hours. Dynamics ate a bit different from a garden variety therapy practice, though - what they do is time-limited and while a need for medication will exist for most folks indefinitely they do actually graduate from therapy at a good clip. They might occasionally return to therapy from time to time but I fully anticipate eventually having more patients than their current census even without having to take in folks directly who have never engaged with them.

I was offered a CMHC gig taking over someone's 600 patient panel with 20 min follow ups ('you get 40 for new patients if they just got out of the hospital because you already have the h&p'), hard pass.

I'm working in a CMHC outpatient job and my intakes are 90 min & follow ups are 30 min. I could do the intakes in 60 min if they always arrived on time but they don't and we account for that. I get around 3h of admin time/day also. Patients show up early/late and often quite sick so it's still chaotic at times so 20 min for FU and 40 min for intakes = nope. I'm part time but FT panel is around 120.

 

[clausewitz2]

I'm working in a CMHC outpatient job and my intakes are 90 min & follow ups are 30 min. I could do the intakes in 60 min if they always arrived on time but they don't and we account for that. I get around 3h of admin time/day also. Patients show up early/late and often quite sick so it's still chaotic at times so 20 min for FU and 40 min for intakes = nope. I'm part time but FT panel is around 120.

This place was like "you get twenty minutes of admin time every day at noon! Your lunch break is 40 minutes."

 

[futuredo32]

This volume of theirs isn't that much...
A 35-40 hour per week clinical Psychiatrist emphasizing 30 minute med checks on a lower end will have a full practice with 400 patients. I have very little therapy patients, and projections for my style of practice with 30 min follow ups, and pushing out no further then 3 months, subtracting an average vacation allotment in that 3 month window, I could possible have an upper panel of 760 patients, but anticipate being the in the low 300's for for a 30hr clinical work week.

cash or insurance?

 

[Sushirolls]

cash or insurance?

Insurance

 

[AD04]

In the meanwhile, if you want to start a practice, start a practice, or join an MD-based practice. There's zero upside in being employed by a psychologist driven practice, unless they pay you equity from day 1. This is also why this arrangement is uncommon. Medical directors of PhD driven practices typically have ownership stakes. Especially if you take insurance, referrals will go the way of you --> PhDs, not the other way around.

What would be the advantage of an MD-based practice, especially a single-specialty practice? You may get better rates but wouldn't volume be lower as there is more competition within the same group?

 

[TexasPhysician]

What would be the advantage of an MD-based practice, especially a single-specialty practice? You may get better rates but wouldn't volume be lower as there is more competition within the same group?

No. Single specialty practices are well known for that specialty if they are doing their job right. Despite another CAP already, my practice is booked about 1 month out for new evals. I advertised at the beginning and have done great marketing though. Finding another good CAP can be difficult depending on location. Patients will drive long distances to be seen in 1 week rather than 1 month even with a good reputation. I could fill another CAP quickly.

A psychologist can be full doing 1 eval and report per day. It’s very low volume, and no one in the community is referring psychiatry cases there. You’d be better off going it alone and bringing in your own psychologist.

 

[dl2dp2]

What would be the advantage of an MD-based practice, especially a single-specialty practice? You may get better rates but wouldn't volume be lower as there is more competition within the same group?

Agree with TexasPhysician. For what it's worth, competition within an MD practice group generally are not cited as an issue in physician salary. For one thing, the demand for MD service is much much MUCH higher than for PhD services. For another, the aura of a senior partner in a community often rubs off on a junior partner, and especially if the junior partner has compelling credentials, I suspect few patients would object if he fills in for the senior partner if they work together. Typically reasons for MD salary differentials come from how much you are willing to work, rather than your ability to attract patients.