Exempt vs Non-Exempt paid per service employee?

[quickpsych]

While not confirmed , a company I do work for as a FFS psychologist, stated they are testing out moving from exempt to non-exempt status for all staff while also testing "having everyone clock in and out when they do work related tasks, notes, and time spent at sites providing services."

Presently I get paid X rate per X service completed. Which includes notes. Company does sometimes provide "administrative" pay at an hourly rate for things like trainings but isn't too common. As it stands, it's on me to show up, do the work, document the work, etc. The more I work the more I make, the less I work, the less I make. Which is fine, freedom and flexibility is better than show up from 9-5 for me, not having to submit time sheets or time off approvals is ::chefs kiss" for me right now.

A few red flags went up, such as court rulings in various states that psychologists and other licensed mental health professionals do meet the criteria for exempt status, same as medical doctors and others as "learned professionals" as well as what I understand from DOL regulations that if you're on the clock you need to be paid for that time as well. Also it appears if I do "work" related tasks at home, which we do, and then drive to a site this would constitute driving from "worksite to worksite" during work hours (i.e. if required to clock in) and thus would need to be compensated, no? It's also my understanding that in the event they classify FFS as non-exempt employees, if this tracked time "worked" exceeds 40 hours a week they'd then have to pay overtime although as of now even salaried psychologists are salaried based on full time productivity.

Overall happy with the company and the work, but this is rubbing me the wrong way and seems like it could run afoul of labor laws, as well as probably have a few psychologists heading for the doors.

It's framed as allowing us to receive sick time accrual (although no one knows what that hourly rate would be) and "exciting to help improve efficiency."

I asked a colleague and they had no idea the difference between exempt and non exempt employment status, which the pragmatist in me wonders if they're banking on not knowing the regulations, rights, and classifications and framing it as "a great thing for everyone!."

The business sense in me always thought FFS is more lucrative for a company (only pay when a service is billed) so I'm quite perplexed why they would risk spending more money while possibly losing those who can bill and make them money.

I've always been skeptical of any time of clock in and out approach. Especially when there's enough date from EHR logs to get the info managers might need.

I'm probably overthinking this, so I'll intellectualize it for the mystery of this possible business move.

Thoughts? Anyone else work in this kind of arrangement?

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[Therapist4Chnge]

I’d consult an employment attorney bc that employer is walking through a mine field and you want to make sure you are protected and you know what they can and cannot require of you.

 

[quickpsych]

I’d consult an employment attorney bc that employer is walking through a mine field and you want to make sure you are protected and you know what they can and cannot require of you.

Thank you for reply. Obviously have to look out for my own interests and will consult an attorney if it is true. But I'd say , yes you nailed it, it's a mine field for them. Up until this they've been pretty by the books and asking us for feedback before implementing changes. It's also possible it's a "test program" to use payroll software to track this data but even then, that's a mine field across multiple jurisdictions for them.


On a side note, My soapbox on perplexing, mine field like changes: private equity ruins, or at least screws up, everything it touches. Company had recently had an "Investment" from some private equity shop. I would not be surprised if some of these proposed changes are from that.

 

[Sanman]

Thank you for reply. Obviously have to look out for my own interests and will consult an attorney if it is true. But I'd say , yes you nailed it, it's a mine field for them. Up until this they've been pretty by the books and asking us for feedback before implementing changes. It's also possible it's a "test program" to use payroll software to track this data but even then, that's a mine field across multiple jurisdictions for them.


On a side note, My soapbox on perplexing, mine field like changes: private equity ruins, or at least screws up, everything it touches. Company had recently had an "Investment" from some private equity shop. I would not be surprised if some of these proposed changes are from that.

Investment or purchase? Usually the groups purchase with a 3 year buyout from current ownership.

 

[quickpsych]

Investment or purchase? Usually the groups purchase with a 3 years buyout from current ownership.

Described as a lower middle market "investment partner" with "the existing leadership and founder of the company maintaining ownership" and the "investors" to "help with funding the expansion of our services to more locations."

But I suspect you're right, the goal would be buyout if they find it's profitable to own or buy and sell into a larger organization.

 

[Sanman]

Described as an "investment partner" with "the existing leadership and founder of the company maintaining ownership" to "help with the expansion of our services to more locations."

One man's opinion, start looking for a new job. I have found that this usually leads to a focus on short-term growth at the expense of quality and long-term job satisfaction. My guess is that they will ramp up growth, things will be disorganized, and the whole thing will be sold in a few years when the numbers justify a buyout. I may be wrong, but this has been my experience.

 

[quickpsych]

One man's opinion, start looking for a new job. I have found that this usually leads to a focus on short-term growth at the expense of quality and long-term job satisfaction. My guess is that they will ramp up growth, things will be disorganized, and the whole thing will be sold in a few years when the numbers justify a buyout. I may be wrong, but this has been my experience.

Sounds about right, see this in other industries. I know you and I disagree at times on things on this forum, but I recall you saying you worked in a similar arrangement and settings and I would agree with your experiences at those places.

They are indeed "ramping up growth." They've been pretty transparent in terms of sharing they have more facility contracts than clinicians available, and are trying to figure out how to hire more. But it's also showing cracks in their organization as they reach for growth as they're a few individuals managing dozens, if not more, clinicians. Time will tell.

If anything these changes have cemented my firm stance that I wouldn't go back to salaried in most of these types of jobs.

 

[PsyDr]

1) They are doing this for a reason that benefits them. A few possibilities::

a. there is some regulatory issue that requires this (e.g., they misclassified employees and got in trouble with the IRS or FSLA).

b. they are going to use the time tracking to come up with an average hourly rate that is lower than what they are paying. It would be reasonable to assume there is some data to suggest they are overpaying someone. It would also be reasonable to assume this is a ploy to justify lower hourly rates (e.g., "Our data says there is a 35% productivity rate, at $100/hr, you're really making $35/hr, but we are going to pay you $50/hr instead!")

c. There is some reason they want to expand the business to use big box payroll stuff.

2) If you are wise, you will document the heck out of each thing you to, including phone time, email time, commute time, etc. There are CPT codes for record reviews, case conferences, emails, etc.

3) I would plan on being fired. Best case scenario: they are going to ask you to remain in the FFS thing. Worst case: they fire you for some BS reason, and you have to report them to your state's BOL for lost wages.

 

[Sanman]

Sounds about right, see this in other industries. I know you and I disagree at times on things on this forum, but I recall you saying you worked in a similar arrangement and settings and I would agree with your experiences at those places.

They are indeed "ramping up growth." They've been pretty transparent in terms of sharing they have more facility contracts than clinicians available, and are trying to figure out how to hire more. But it's also showing cracks in their organization as they reach for growth as they're a few individuals managing dozens, if not more, clinicians. Time will tell.

If anything these changes have cemented my firm stance that I wouldn't go back to salaried in most of these types of jobs.

Agree with the bolded. I imagine you will be getting some calls begging you to cover extra facilities. Expect some key managers to quit soon. The private equity groups that invest have a playbook and they would have put out a statement upon becoming a partner in the company. Take a look at what they have done in the past.

 

[Therapist4Chnge]

Outside investor money....now my recommendation to speak with an employment attorney is x10. Most of them follow the same consulting playbook because they all use the same handful of consulting firms. The short version is they are not your friend, and you want to not only document your current job, then what changes they want to make, and how that impacts you. In a best case scenario, they screw up royally, and then you can sue for wrongful termination, violation of employment law, etc. The employment lawyer can also guide you as to what to do if/when they want you to sign an NDA and what kind of leverage you may have, depending on how well/poorly they are handling these upcoming changes.

 

[ClinicalABA]

Sounds about right, see this in other industries. I know you and I disagree at times on things on this forum, but I recall you saying you worked in a similar arrangement and settings and I would agree with your experiences at those places.

They are indeed "ramping up growth." They've been pretty transparent in terms of sharing they have more facility contracts than clinicians available, and are trying to figure out how to hire more. But it's also showing cracks in their organization as they reach for growth as they're a few individuals managing dozens, if not more, clinicians. Time will tell.

If anything these changes have cemented my firm stance that I wouldn't go back to salaried in most of these types of jobs.

My guess is the new guys are not pure growth equity, looking to expand an existing model of service delivery. Private equity investment is often done to make a quick profit, with the end results being another sale in a few years, where debts are passed on to others as the equity is sucked out. The only way to make more money at higher margins is to produce more while paying less for the raw materials and processing systems. Basically- your work now needs to pay somebody else who likely has no idea what your work is, why it's being done, how it should be done, etc. I'm not going to say that they are monsters who don't care about harming clients, but their primary mission is to make a lot of money very quickly. Other objectives (quality of care, clinician job satisfaction) are only important to the extent that they don't interfere with the primary mission. The fact that they are taking on new contracts/facilities without the actual ability to provide the service is probably the surest sign that it's no longer about quality of care. They'll cash those checks, put in a skeleton team of clinicians and middle management to deal with the BS on the ground, and then sell off to the next guys without ever having to even see the non-financial results of what they have done.

Here's an article on what private equity is doing in my area (autism treatment). Not a pretty picture. Pocketing Money Meant for Kids: Private Equity in Autism Services

 

[ClinicalABA]

1) They are doing this for a reason that benefits them. A few possibilities::

...

I'd also add the possibility that it's possibly just how they do things in the other companies that make up their overall portfolio, and they are just trying to standardize this across their companies.

A private equity firm acquired my previous company, putting my MA based company under the senior management of their CA based autism service provider. One of the first things they wanted to do was consolidate payroll and have ours managed by and following the same timelines as the CA company, which paid twice-monthly (we paid every other week). They did a lot of work to merge the payrolls, set up new pay schedules, put together a training for our staff on the new payroll systems (including flying someone out from CA to do some in-person trainings. First I heard of all this was when they sat down with our local senior management team (I was the director of operations at this point) at the beginning of the week to go over the changes. I informed them that MA law required paying non-exempt employees within two weeks of the date the work work was done, thus making the twice per month schedule not legal. They never checked on any of this beforehand, did all this work, and then had to backtrack. They also switched the scheduling of home-based services in MA to people in Los Angeles who just looked at a map and drew a straight line between houses to calculate travel time, without accounting for the very large river with bridges only every 10-15 miles. What looked like a 5 minute drive could actually take 30 minutes. This is the kind of stuff that the OP is potentially in for. You may actually find that some salaries initially INCREASE- especially for new hires- as they attempt to lure staff from competitors in order to build market share, later passing on these unsustainably high salaries and the debt acquired to cover them (a lot of these are leveraged buyouts, done a 90-10 debt to equity rations) to the next PE firm, repeating as necessary until the regulators catch on or we have another 2008 scenario where it all falls apart. Meanwhile, the individual PE managing partners are insulated from any legal risks, as the blame remains with the senior management of the individual companies making up the portfolio.

I left within 6 months. The day-to-day stuff was just not worth it. Most of the senior clinical staff (BCBAs) were gone within the year (despite the totally not-legal-in-MA non-compete clauses in their new contracts). Many took their clients with them to their new agencies (again despite the not-legal restrictive covenant in their contracts against doing so!). This was in 2013. Turns out the PE firm (Scopia) sold the now-bigger company to another PE firm (FFL partners) in 2017, making for the 4th such sale within the 7 year period between 2009 and 2017- each of which likely came with big (and little, paper-cut variety) changes to how things were done. Oh- each sale also resulted in increased reports of ethical abuses related to access to care and direct client experiences, as well as increases in documented billing fraud. It's such a great model for mental health care!

 

[quickpsych]

1) They are doing this for a reason that benefits them. A few possibilities::

a. there is some regulatory issue that requires this (e.g., they misclassified employees and got in trouble with the IRS or FSLA).

b. they are going to use the time tracking to come up with an average hourly rate that is lower than what they are paying. It would be reasonable to assume there is some data to suggest they are overpaying someone. It would also be reasonable to assume this is a ploy to justify lower hourly rates (e.g., "Our data says there is a 35% productivity rate, at $100/hr, you're really making $35/hr, but we are going to pay you $50/hr instead!")

c. There is some reason they want to expand the business to use big box payroll stuff.

2) If you are wise, you will document the heck out of each thing you to, including phone time, email time, commute time, etc. There are CPT codes for record reviews, case conferences, emails, etc.

3) I would plan on being fired. Best case scenario: they are going to ask you to remain in the FFS thing. Worst case: they fire you for some BS reason, and you have to report them to your state's BOL for lost wages.

Apparently on point a. , they did confirm there is a regulatory law in the state I work in (and they are based in another state) where anyone classified as employees have to have sick time accrual of 1 hour per 40 hours worked. They W-2 everyone so I guess that classifies me as an employee, although not sure why I need to be switched to non-exempt to help this. They shared in writing from an official email account that they are not interested in anything but documenting hours worked to have documentation to ensure they are compliant with state regulations. I guess they figured their payroll software made sense to just use for this.

Point b. - I suspect this. They've been pretty transparent over time. When they first hired me as salaried, they admitted later they over estimated how much to pay and underestimated how much work needed where I was placed. I asked to go to FFS when faced with commute to further facilities 5 days a week or just work FFS and accept closer facilities. I make more and work less and commute less. They don't have to give me money unless I bill a service. For now, works great. I agree with you that they're likely data harvesting this info to hire new people at lower rates.

2. - I definitely keep emails and download records of my EHR productivity. Unfortunately they do not accept or process any billing codes for anything other than a billable direct face to face service. They consider documentation as part of the fee for the service billed.

3.) I don't think they'd fire me. Not for any outstanding altruism or professional recognition...just that I get notes done on time, they can bill successfully for my services, and they get money. I actually prefer FFS. They have asked me if I wanted to go back to salary last year which is not something I'd do. I would strongly consider leaving, even though it's been a great gig on my side mostly, if they ended FFS and forced me back to salary or if they slashed my rates.

Agree with the bolded. I imagine you will be getting some calls begging you to cover extra facilities. Expect some key managers to quit soon. The private equity groups that invest have a playbook and they would have put out a statement upon becoming a partner in the company. Take a look at what they have done in the past.

Oh yes, I get those calls every few months. Sometimes I say sure, sometimes I decline. My direct manager had no idea of this change for clocking in and out, so yes I do expect some "good" managers to leave and be replaced by people who have no idea how anything works. This PE firm appears to have formed last year by a few people and has investments in six companies in education and healthcare.

Outside investor money....now my recommendation to speak with an employment attorney is x10. Most of them follow the same consulting playbook because they all use the same handful of consulting firms. The short version is they are not your friend, and you want to not only document your current job, then what changes they want to make, and how that impacts you. In a best case scenario, they screw up royally, and then you can sue for wrongful termination, violation of employment law, etc. The employment lawyer can also guide you as to what to do if/when they want you to sign an NDA and what kind of leverage you may have, depending on how well/poorly they are handling these upcoming changes.

Now that I have more info, ie in writing what they say they are and are not using this clock and time data for, I think I could spring for an attorney to least look over this situation.

My guess is the new guys are not pure growth equity, looking to expand an existing model of service delivery. Private equity investment is often done to make a quick profit, with the end results being another sale in a few years, where debts are passed on to others as the equity is sucked out. The only way to make more money at higher margins is to produce more while paying less for the raw materials and processing systems. Basically- your work now needs to pay somebody else who likely has no idea what your work is, why it's being done, how it should be done, etc. I'm not going to say that they are monsters who don't care about harming clients, but their primary mission is to make a lot of money very quickly. Other objectives (quality of care, clinician job satisfaction) are only important to the extent that they don't interfere with the primary mission. The fact that they are taking on new contracts/facilities without the actual ability to provide the service is probably the surest sign that it's no longer about quality of care. They'll cash those checks, put in a skeleton team of clinicians and middle management to deal with the BS on the ground, and then sell off to the next guys without ever having to even see the non-financial results of what they have done.

Here's an article on what private equity is doing in my area (autism treatment). Not a pretty picture. Pocketing Money Meant for Kids: Private Equity in Autism Services

Sounds about right. Ironically many of the facilities I go into are owned by massive PE firms that do exactly this. Is disgusting this kind of stuff is legal in healthcare.

I'd also add the possibility that it's possibly just how they do things in the other companies that make up their overall portfolio, and they are just trying to standardize this across their companies.

A private equity firm acquired my previous company, putting my MA based company under the senior management of their CA based autism service provider. One of the first things they wanted to do was consolidate payroll and have ours managed by and following the same timelines as the CA company, which paid twice-monthly (we paid every other week). They did a lot of work to merge the payrolls, set up new pay schedules, put together a training for our staff on the new payroll systems (including flying someone out from CA to do some in-person trainings. First I heard of all this was when they sat down with our local senior management team (I was the director of operations at this point) at the beginning of the week to go over the changes. I informed them that MA law required paying non-exempt employees within two weeks of the date the work work was done, thus making the twice per month schedule not legal. They never checked on any of this beforehand, did all this work, and then had to backtrack. They also switched the scheduling of home-based services in MA to people in Los Angeles who just looked at a map and drew a straight line between houses to calculate travel time, without accounting for the very large river with bridges only every 10-15 miles. What looked like a 5 minute drive could actually take 30 minutes. This is the kind of stuff that the OP is potentially in for. You may actually find that some salaries initially INCREASE- especially for new hires- as they attempt to lure staff from competitors in order to build market share, later passing on these unsustainably high salaries and the debt acquired to cover them (a lot of these are leveraged buyouts, done a 90-10 debt to equity rations) to the next PE firm, repeating as necessary until the regulators catch on or we have another 2008 scenario where it all falls apart. Meanwhile, the individual PE managing partners are insulated from any legal risks, as the blame remains with the senior management of the individual companies making up the portfolio.

I left within 6 months. The day-to-day stuff was just not worth it. Most of the senior clinical staff (BCBAs) were gone within the year (despite the totally not-legal-in-MA non-compete clauses in their new contracts). Many took their clients with them to their new agencies (again despite the not-legal restrictive covenant in their contracts against doing so!). This was in 2013. Turns out the PE firm (Scopia) sold the now-bigger company to another PE firm (FFL partners) in 2017, making for the 4th such sale within the 7 year period between 2009 and 2017- each of which likely came with big (and little, paper-cut variety) changes to how things were done. Oh- each sale also resulted in increased reports of ethical abuses related to access to care and direct client experiences, as well as increases in documented billing fraud. It's such a great model for mental health care!

Also sounds about right. I'm amazed these companies are allowed to operate in this manner (the PEs). I mean I'm not surprised as capitalism rules all, but still. Appreciate you sharing this experience as well. You shared they were not in compliance with state law, I think or least assume the response I got from my company spelling out the why and the why not was because I asked questions directly related to compliance with state law (i.e. paying time clocked in or not, sick time accrual rates, professional exemptions per state).


The TL;DR: As of now the company has informed me this is strictly to remain in compliance with state regulations regarding tracking hours worked for accrual of sick time. However they did not yet clarify how they intend to pay out or utilize sick time. I'm not sure they know yet, but we shall see.

 

[ClinicalABA]

...

Also sounds about right. I'm amazed these companies are allowed to operate in this manner (the PEs). I mean I'm not surprised as capitalism rules all, but still....

Yeah- it's pretty crazy stuff when you look into into. Highly leveraged buyouts (i.e., borrowing 90% of the purchase price) as a standard practice tends to end up with bad things happening. Most of the PE funds and their portfolio companies are not publicly traded, so they they don't have to report very much- if anything- to oversight agencies (such as the Securities and Exchange Commission). Because it's mental health care agencies, they generally aren't subject to Corporate Practice of Medicine Laws that- at a minimum- will typically require that a physician be in charge. The PE manage takes all the control of the company, but none of the legal risk or client ethical obligations (that all stays at the level of the company that is bought). There's not even much financial risk involved, as they are putting up very little of their own money to acquire the companies. Dirty, filthy stuff that seeks only to make money off the mental illness of others. While my own income is dependent on the mental illness of others, I have direct responsibility for their optimal wellbeing and ethical treatment others, as well as culpability for any wrong doing. I find it hard to believe that f**king David de Rothschild gives two s**ts whether or my client ever learns to talk or dress himself, but rather that he gets a few extra pennies out what each 15 minute direct service code pays us.

Sorry for such doom and gloom responses, and also that you are going through this with your current employers. It'll work out there or not- but always remember that there is a huge need for our services and still plenty of opportunities for a well trained, competent clinician to make a good living without lining the pockets of someone who just happens to be the great-great-great-great grandson of some guy who got lucky with a bank in the Holy Roman Empire.

 

[Sanman]

Yeah- it's pretty crazy stuff when you look into into. Highly leveraged buyouts (i.e., borrowing 90% of the purchase price) as a standard practice tends to end up with bad things happening. Most of the PE funds and their portfolio companies are not publicly traded, so they they don't have to report very much- if anything- to oversight agencies (such as the Securities and Exchange Commission). Because it's mental health care agencies, they generally aren't subject to Corporate Practice of Medicine Laws that- at a minimum- will typically require that a physician be in charge. The PE manage takes all the control of the company, but none of the legal risk or client ethical obligations (that all stays at the level of the company that is bought). There's not even much financial risk involved, as they are putting up very little of their own money to acquire the companies. Dirty, filthy stuff that seeks only to make money off the mental illness of others. While my own income is dependent on the mental illness of others, I have direct responsibility for their optimal wellbeing and ethical treatment others, as well as culpability for any wrong doing. I find it hard to believe that f**king David de Rothschild gives two s**ts whether or my client ever learns to talk or dress himself, but rather that he gets a few extra pennies out what each 15 minute direct service code pays us.

Sorry for such doom and gloom responses, and also that you are going through this with your current employers. It'll work out there or not- but always remember that there is a huge need for our services and still plenty of opportunities for a well trained, competent clinician to make a good living without lining the pockets of someone who just happens to be the great-great-great-great grandson of some guy who got lucky with a bank in the Holy Roman Empire.

Unfortunately, PE has completely taken over the nursing home industry and associated contractors. It has really hurt the future of geriatric health and mental health and limited the job opportunities for good geriatric clinicians.

 

[WisNeuro]

Unfortunately, PE has completely taken over the nursing home industry and associated contractors. It has really hurt the future of geriatric health and mental health and limited the job opportunities for good geriatric clinicians.

They keep advertising for contracted positions for psychologists to go in and do evals/therapy around here, but the pay is laughably low.

 

[Therapist4Chnge]

PE has yet to find a business they can't ruin, and quickly.

I agree with the OP about FFS, if structured right it can offer greater flexibility.

 

[quickpsych]

Yeah- it's pretty crazy stuff when you look into into. Highly leveraged buyouts (i.e., borrowing 90% of the purchase price) as a standard practice tends to end up with bad things happening. Most of the PE funds and their portfolio companies are not publicly traded, so they they don't have to report very much- if anything- to oversight agencies (such as the Securities and Exchange Commission). Because it's mental health care agencies, they generally aren't subject to Corporate Practice of Medicine Laws that- at a minimum- will typically require that a physician be in charge. The PE manage takes all the control of the company, but none of the legal risk or client ethical obligations (that all stays at the level of the company that is bought). There's not even much financial risk involved, as they are putting up very little of their own money to acquire the companies. Dirty, filthy stuff that seeks only to make money off the mental illness of others. While my own income is dependent on the mental illness of others, I have direct responsibility for their optimal wellbeing and ethical treatment others, as well as culpability for any wrong doing. I find it hard to believe that f**king David de Rothschild gives two s**ts whether or my client ever learns to talk or dress himself, but rather that he gets a few extra pennies out what each 15 minute direct service code pays us.

Sorry for such doom and gloom responses, and also that you are going through this with your current employers. It'll work out there or not- but always remember that there is a huge need for our services and still plenty of opportunities for a well trained, competent clinician to make a good living without lining the pockets of someone who just happens to be the great-great-great-great grandson of some guy who got lucky with a bank in the Holy Roman Empire.

You'd think there would be more oversight, or perhaps our advocacy groups and professional groups doing more to pressure for more oversight and standards when our profession is becoming entwined in this problem.

Thank you, I appreciate the acknowledging of going through it , and the doom and gloom of these kinds of places and situations. I've worked at worse companies (one was a community health center run by some real characters) so I see it and get it, just annoying when you think you've got a low stress set up then they just throw a wrench in. Or at least low stress from the management and back end so can focus on the work itself. I agree the demand is huge, It's a shame that sometimes the populations that need it or benefit from it the most lose out more and more thanks to private equity. Eventually I'd probably revisit the telehealth private practice idea in due time.

What worries me too is that there's plenty of great psychologists in the field who , perhaps naively, think "well don't worry, we're the doctors, the license holders, they HAVE to listen to us and take our recommendations into how to operate or what to do. We have the power!" Not realizing , well, depends whose running what and how much someone else is cheaper to do the same job they want done.

Unfortunately, PE has completely taken over the nursing home industry and associated contractors. It has really hurt the future of geriatric health and mental health and limited the job opportunities for good geriatric clinicians.

Indeed they have. Seeing these places first hand what always was absurd was how much work went into decorative renovations in a place when a new "owner" took over. And without fail, long time residents of the places lamenting how everything from staffing levels to food quality goes down. It's like a playbook. I'm actually surprised they haven't started consolidating ones they own or cramming 3 beds to a room in every room so they can sell of the real estate the old ones are using. It really does hurt the future of healthcare in general.

They keep advertising for contracted positions for psychologists to go in and do evals/therapy around here, but the pay is laughably low.

Now I'm curious, what kind of pay rates are they offering these days?

 

[quickpsych]

PE has yet to find a business they can't ruin, and quickly.

I agree with the OP about FFS, if structured right it can offer greater flexibility.

Everything they touch eventually fails. If there's real estate attached to the business, woo boy, they really get to destroying things to get that sweet real estate owned, sold, or leased out. You're seeing this trend not only in healthcare and retail, but also breweries, gaming companies, bagel shops. You name it, they want to cripple it with debt and get the profits off the pieces of what's left after failure.

I see some great FFS deals and some terrible ones.

 

[Sanman]

You'd think there would be more oversight, or perhaps our advocacy groups and professional groups doing more to pressure for more oversight and standards when our profession is becoming entwined in this problem.

Thank you, I appreciate the acknowledging of going through it , and the doom and gloom of these kinds of places and situations. I've worked at worse companies (one was a community health center run by some real characters) so I see it and get it, just annoying when you think you've got a low stress set up then they just throw a wrench in. Or at least low stress from the management and back end so can focus on the work itself. I agree the demand is huge, It's a shame that sometimes the populations that need it or benefit from it the most lose out more and more thanks to private equity. Eventually I'd probably revisit the telehealth private practice idea in due time.

What worries me too is that there's plenty of great psychologists in the field who , perhaps naively, think "well don't worry, we're the doctors, the license holders, they HAVE to listen to us and take our recommendations into how to operate or what to do. We have the power!" Not realizing , well, depends whose running what and how much someone else is cheaper to do the same job they want done.


Indeed they have. Seeing these places first hand what always was absurd was how much work went into decorative renovations in a place when a new "owner" took over. And without fail, long time residents of the places lamenting how everything from staffing levels to food quality goes down. It's like a playbook. I'm actually surprised they haven't started consolidating ones they own or cramming 3 beds to a room in every room so they can sell of the real estate the old ones are using. It really does hurt the future of healthcare in general.


Now I'm curious, what kind of pay rates are they offering these days?

Lol, you haven't been around long enough. I've seen 4 beds to a room before. Though most facilities have phased that out. Ever seen places where staff are engaging in prostitution in the parking lot? Drug dealing? Selling desserts and junk food to diabetic residents after hours? Seen employees hide in restrooms when family comes to visit?

That said, I have seen families treat patients just as badly in order to avoid losing the family home to the medicaid/LTC process. There is a lot of ugliness out there and it allows things like PE to thrive because a lot of people don't care.

The only power a "doctor" has is the power to not be a part of a corrupt process. For that, you need to be financially stable enough to walk away. There is a generation coming up so far in debt that most will never know that power. That is F U money. Folks in debt are just cheap labor.

 

[WisNeuro]

Now I'm curious, what kind of pay rates are they offering these days?

Bout 50/hr. Almost as laughable as the private companies taking over the C&Ps in the area and offering $500 a day and trying to make it sound like a lot for doing medcicolegal work.

 

[ClinicalABA]

Very coincidentally I received a spam training offer email this morning with the following subject:

"2024 Guide for Exempt vs. Non-Exempt Employees: Understanding New Overtime Exemptions Under the FLSA"

I did some research, and turns out the Dept. of Labor has issued a new Final Rule regarding classification of employees as exempt/non-exempt. The short version is they are now emphasizing the extent to which the worker is economically dependent on the agency. FFS or not, if you are doing work primarily for one company and the pay from this company is how you support yourself, you are not an independent contractor but rather an employee of that agency, and are thus subject to applicable laws related to overtime, sick pay, membership in bargaining units, etc. Doesn't matter what you call yourself (e.g., "independent contractor"), but what you do (e.g. work exclusively/primarily for one company). FFS is not an employee classification and is irrelevant. The direct clinical staff (BA level) at my agency are all FFS, but considered full-time employees and thus eligible for all benefits and protections that status requires.

PE still is the devil, but your situation is more likely the result of these recent rule changes than any subterfuge of the glitterati.

 

[PsyDr]

@quickpsych

There is a reason I am suggesting that you use every applicable CPT code. It does not matter if they "don't pay for that". They are tracking your time. If you do not enter everything into their system, then they will assume you are drawing pictures of daisies instead of working. If you accurately track you work, they can't say that you are not working full time or deny you overtime. If you don't, they can.

Also: By doing so, you have created a case for unclaimed wages with your state's DOL. Any attorney will notice that, and tell HR it would cost them too much money to mess with you.

 

[Sanman]

Bout 50/hr. Almost as laughable as the private companies taking over the C&Ps in the area and offering $500 a day and trying to make it sound like a lot for doing medcicolegal work.

Sounds about right. I recall the rate being 30-35/hr about a decade ago.

 

[smalltownpsych]

A private equity firm bought the residential treatment program I worked at a few years ago, they started out in the background and left former owners in charge for a period of time. When they discontinued that and I met with them about the new plans it quickly became clear that they had no idea what they were doing and were focused on rapid growth to the exclusion of anything else. This was incompatible with my own philosophy and even their growth strategy was flawed. I put in my notice per contract of 90 days and they fired me 30 days later. I started my own business and two years later their business has shrunk dramatically and I’m doing ok. My wife often says I’m a Pollyanna, but I believe I can run a business well and provide a good service and pay employees well and still be able to make a decent living. My goal is not to be wealthy, it is actually to help people and feel good about it and make enough money to retire and have a few nice things.

 

[ClinicalABA]

A private equity firm bought the residential treatment program I worked at a few years ago, they started out in the background and left former owners in charge for a period of time. When they discontinued that and I met with them about the new plans it quickly became clear that they had no idea what they were doing and were focused on rapid growth to the exclusion of anything else. This was incompatible with my own philosophy and even their growth strategy was flawed. I put in my notice per contract of 90 days and they fired me 30 days later. I started my own business and two years later their business has shrunk dramatically and I’m doing ok. My wife often says I’m a Pollyanna, but I believe I can run a business well and provide a good service and pay employees well and still be able to make a decent living. My goal is not to be wealthy, it is actually to help people and feel good about it and make enough money to retire and have a few nice things.

Many of us could run a reasonably efficient, clinically sound company that paid us and others a good salary and- most importantly- provided a very high standard of care to our clients. What I'm not as good at as the PE folks is running a company that will- in short period of time (e.g., 2-5 years), increase in sale value enough to a) pay off the loan(s) I took out to purchase it, and b) give me returns at well above average stock market rates (e.g., 3 times the 6.7% avg. annual returns of the DJI over the past few decades).

The only real way to do this is to quickly increase market share, and the best (really only, given the timeframes demanded by investors) ways to do that are to offer more services with same (or less) amount of staff. If you need more staff to do that, either rely on the cheap and not so good ones (thus immediately reducing quality of service), or- if you really need to build capacity quickly- offer higher than market rates but ultimately unsustainable salaries to lure new staff in (and away from your competitors), and then sell to the next guys and let them deal with the unsustainable salaries by going with the first option of underpaying staff now that you have the increased market share and have weakened the competition. The only way to do any of this safely (only financially speaking- you don't have to care about legal/ethical/patient care safety in this model) is to make sure that the company and business type represents only a very small portion of your overall portfolio, thus necessitating the use of senior management who are experts in making money rather than the area of business of the individual company.

TLDR- know who owns the place you work or might work. If it's PE, don't support the system because you don't have to.

 

[quickpsych]

Lol, you haven't been around long enough. I've seen 4 beds to a room before. Though most facilities have phased that out. Ever seen places where staff are engaging in prostitution in the parking lot? Drug dealing? Selling desserts and junk food to diabetic residents after hours? Seen employees hide in restrooms when family comes to visit?

That said, I have seen families treat patients just as badly in order to avoid losing the family home to the medicaid/LTC process. There is a lot of ugliness out there and it allows things like PE to thrive because a lot of people don't care.

The only power a "doctor" has is the power to not be a part of a corrupt process. For that, you need to be financially stable enough to walk away. There is a generation coming up so far in debt that most will never know that power. That is F U money. Folks in debt a just cheap labor.

Sad but true, sounds sadly right.

Very coincidentally I received a spam training offer email this morning with the following subject:

"2024 Guide for Exempt vs. Non-Exempt Employees: Understanding New Overtime Exemptions Under the FLSA"

I did some research, and turns out the Dept. of Labor has issued a new Final Rule regarding classification of employees as exempt/non-exempt. The short version is they are now emphasizing the extent to which the worker is economically dependent on the agency. FFS or not, if you are doing work primarily for one company and the pay from this company is how you support yourself, you are not an independent contractor but rather an employee of that agency, and are thus subject to applicable laws related to overtime, sick pay, membership in bargaining units, etc. Doesn't matter what you call yourself (e.g., "independent contractor"), but what you do (e.g. work exclusively/primarily for one company). FFS is not an employee classification and is irrelevant. The direct clinical staff (BA level) at my agency are all FFS, but considered full-time employees and thus eligible for all benefits and protections that status requires.

PE still is the devil, but your situation is more likely the result of these recent rule changes than any subterfuge of the glitterati.

Good information. And may be correct, this is probably the regulation they're referring to. So on that topic, I have no qualms if that's the move they need to make to be in compliance. However, I think they're setting themselves up for a problem if they aren't planning how to pay/compensate sick time as well as time on the clock. Maybe they think it's easier and less hassle to just use the payroll software clock in/out then chase timesheets getting submitted. Then again, if there's no way for me to submit CPT codes or documenting what I'm doing during that clocked in, non direct service time, then they could say it's not payable time. So I'm optimistic it;'s just for the new regulation, but skeptical this is a fine line between telling me to log work time without having to pay for that time (or saying it's paid for by the contracted CPT code rates for services).

@quickpsych

There is a reason I am suggesting that you use every applicable CPT code. It does not matter if they "don't pay for that". They are tracking your time. If you do not enter everything into their system, then they will assume you are drawing pictures of daisies instead of working. If you accurately track you work, they can't say that you are not working full time or deny you overtime. If you don't, they can.

Also: By doing so, you have created a case for unclaimed wages with your state's DOL. Any attorney will notice that, and tell HR it would cost them too much money to mess with you.

It's a great suggestion. Of course their system doesn't have a place or even option to enter any CPT codes, only complete approved services (which are linked to applicable codes on the backend). Although couldn't we chart documenting for drawing pictures of daisies as creating environmental improvements to patient settings and engagement by showing them to patients or hanging them up in patient rooms? 😏

I suppose there may be a way to easily log them on Excel and keep record myself but not sure that would hold up if it came down to a wage dispute?

Sounds about right. I recall the rate being 30-35/hr about a decade ago.

Agreed, seems to be standard especially for salary breakdown assuming 30-40 hours a week.

A private equity firm bought the residential treatment program I worked at a few years ago, they started out in the background and left former owners in charge for a period of time. When they discontinued that and I met with them about the new plans it quickly became clear that they had no idea what they were doing and were focused on rapid growth to the exclusion of anything else. This was incompatible with my own philosophy and even their growth strategy was flawed. I put in my notice per contract of 90 days and they fired me 30 days later. I started my own business and two years later their business has shrunk dramatically and I’m doing ok. My wife often says I’m a Pollyanna, but I believe I can run a business well and provide a good service and pay employees well and still be able to make a decent living. My goal is not to be wealthy, it is actually to help people and feel good about it and make enough money to retire and have a few nice things.

Congrats on the successes of your own business. PE really is getting into every possible area. Growth, not quality.

 

[Sanman]

A private equity firm bought the residential treatment program I worked at a few years ago, they started out in the background and left former owners in charge for a period of time. When they discontinued that and I met with them about the new plans it quickly became clear that they had no idea what they were doing and were focused on rapid growth to the exclusion of anything else. This was incompatible with my own philosophy and even their growth strategy was flawed. I put in my notice per contract of 90 days and they fired me 30 days later. I started my own business and two years later their business has shrunk dramatically and I’m doing ok. My wife often says I’m a Pollyanna, but I believe I can run a business well and provide a good service and pay employees well and still be able to make a decent living. My goal is not to be wealthy, it is actually to help people and feel good about it and make enough money to retire and have a few nice things.

I certainly don't think that is Pollyanna. It is about different goals. Early in my career I was very gung ho about psychology specialty care, future directions, etc. A lot of the established older psychologists still held onto the old models of care and looking back I think they prized their autonomy. Now, being midcareer with a young family, I have done a 180 and am starting to prize my autonomy as well. I commend you for being willing to tackle private practice in your area of expertise. I often struggle with whether to try and do something similar myself or just leave it all behind and move into the more established categories of private practice.

 

[quickpsych]

So it does appear this is due to labor law changes in my state and they do have to give us sick time and have to track time in order to do so. But seems like putting a square block in a circular hole as it doesn't really translate well to providers paid per service and not per hour or per salary.

My company did reply to my inquiry further stating they were not sure what the $$$ rate would be yet for sick time accrual or how it would be credited/compensated when used by an employee who is not salaried and that they were "working on finalizing the numbers and what that looks like in terms of your pay rate for sick time used."

However they still would like me to begin clocking in and out to "make sure the system works and can accrue sick hours."

So regulations seem to be the reason, fair enough, but like how do these companies not think of all this before launching the change? That folks might want to know what their benefits look like before agreeing to them? 🤣 I don't think it's nefarious, more just not knowing the potential problems this can cause, but not knowing isn't an excuse for not following the regulations.

I have to laugh because technically I can now accrue sick time, utilize sick time whatever the rate is, then just when feel better go back to a facility I was out sick in and go conduct my usual fee services another day. So a couple extra bucks some months, just not sure how much.

 

[smalltownpsych]

I would advise looking into your exit strategy and beginning to lay some groundwork for that. Being involved in these situations before, they make decisions without telling anyone or considering how it will affect them or the patients. In other words, they might already be planning on your exit so I have found it’s better to beat them to the punch. Last time I dealt with this, I had already done legal work for starting the company with our accountant and set up a business bank account and secured credit before I gave my notice. It was good that I did that since they accelerated my departure. I am fairly certain that they were already planning for me to leave regardless since I was the highest paid employee and most likely to not agree with their new bad plans.

 

[quickpsych]

I would advise looking into your exit strategy and beginning to lay some groundwork for that. Being involved in these situations before, they make decisions without telling anyone or considering how it will affect them or the patients. In other words, they might already be planning on your exit so I have found it’s better to beat them to the punch. Last time I dealt with this, I had already done legal work for starting the company with our accountant and set up a business bank account and secured credit before I gave my notice. It was good that I did that since they accelerated my departure. I am fairly certain that they were already planning for me to leave regardless since I was the highest paid employee and most likely to not agree with their new bad plans.

A good point for sure. Kind of annoying to have to consider this as a possible outcome as the job is pretty agreeable and can work whenever I want. Overall have a good thing going here, so I'd prefer to just ride the wave as long as I can.

Honestly , and maybe I'll be shown wrong in time, I think depending on their strategy, they would eventually ask or tell me to "go back to salaried or leave." Salaried means they can have more control over the day to day schedule and work and would be less hassle for them to do whatever it is they're trying to do here.

I was probably one of their highest paid psychologists when I was salaried so maybe I dodged something there when I went to FFS agreement.

 

[Sanman]

A good point for sure. Kind of annoying to have to consider this as a possible outcome as the job is pretty agreeable and can work whenever I want. Overall have a good thing going here, so I'd prefer to just ride the wave as long as I can.

Honestly , and maybe I'll be shown wrong in time, I think depending on their strategy, they would eventually ask or tell me to "go back to salaried or leave." Salaried means they can have more control over the day to day schedule and work and would be less hassle for them to do whatever it is they're trying to do here.

I was probably one of their highest paid psychologists when I was salaried so maybe I dodged something there when I went to FFS agreement.

Not sure how many hours you are working for them. However, at least in snf/alf work, it is hard to find full-time providers unless client facilities are large enough or close enough to accommodate such a thing. More often than not FFS is easier for them to manage as they don't have to worry about being upside down if you are not busy enough. More likely, they will bring their FFS and salary percentages into relative parity slowly and you may not see any raises or fee increases if you are on the higher end. Inflation will do the work for them.

 

[quickpsych]

Not sure how many hours you are working for them. However, at least in snf/alf work, it is hard to find full-time providers unless client facilities are large enough or close enough to accommodate such a thing. More often than not FFS is easier for them to manage as they don't have to worry about being upside down if you are not busy enough. More likely, they will bring their FFS and salary percentages into relative parity slowly and you may not see any raises or fee increases if you are on the higher end. Inflation will do the work for them.

Well said. If I factor in on site time, seeing patients, paperwork and supplementary work like emails and reviewing charts I probably work around 18-20 hours a week. Probably 85% or so of my work time is directly seeing patients. I did just get a small increase in my fees earlier this year, which I asked for. I imagine you're correct I probably wouldn't see any fee increases any time soon. I was surprised to learn most of the clinicians are full time salaried. When I started salaried, they were testing telehealth and I had some slow rural facilities I went to, not surprisingly it only took a few months for them to say "happy to have you but we're losing money on you, either take these additional far away facilities or go FFS." So makes sense to me that FFS is low risk, good reward for them as long as I show up and see patients. know they are having trouble filling slots at facilities , and they did already a few months ago try the "you're very reliable and consistent , how about another site!"

As much as I'm annoyed by this whole clock in/out thing, I'd probably be wise to take a step back and count the pros vs the cons and pick and choose my battles carefully here. 🤔

I'm somewhat optimistic this is actually a good thing as FFS. I do wonder what this clock in/clock out data would be used for down the line...I wouldn't be surprised if they (the PE component) will say "hey this guy and the few FFS ones, they really make us decent money in less time and less overhead, why don't we increase productivity requirements for salaried or just make salaried a FFS position!"

Reminds me of a colleague who was excited to , at the time, make around 90k a year plus benefits at a large group practice...."I only have to fill 38 hours a week with therapy sessions, it's great!" So it could be worse lol.

 

[Sanman]

Well said. If I factor in on site time, seeing patients, paperwork and supplementary work like emails and reviewing charts I probably work around 18-20 hours a week. Probably 85% or so of my work time is directly seeing patients. I did just get a small increase in my fees earlier this year, which I asked for. I imagine you're correct I probably wouldn't see any fee increases any time soon. I was surprised to learn most of the clinicians are full time salaried. When I started salaried, they were testing telehealth and I had some slow rural facilities I went to, not surprisingly it only took a few months for them to say "happy to have you but we're losing money on you, either take these additional far away facilities or go FFS." So makes sense to me that FFS is low risk, good reward for them as long as I show up and see patients. know they are having trouble filling slots at facilities , and they did already a few months ago try the "you're very reliable and consistent , how about another site!"

As much as I'm annoyed by this whole clock in/out thing, I'd probably be wise to take a step back and count the pros vs the cons and pick and choose my battles carefully here. 🤔

I'm somewhat optimistic this is actually a good thing as FFS. I do wonder what this clock in/clock out data would be used for down the line...I wouldn't be surprised if they (the PE component) will say "hey this guy and the few FFS ones, they really make us decent money in less time and less overhead, why don't we increase productivity requirements for salaried or just make salaried a FFS position!"

Reminds me of a colleague who was excited to , at the time, make around 90k a year plus benefits at a large group practice...."I only have to fill 38 hours a week with therapy sessions, it's great!" So it could be worse lol.

It's like I have done this before.

Not sure what the RVU requirements are for the salaried folks where you are. At the other PE owned places I knew of the requirement was 12 sessions of 90834 per day. How did they justify this? 12x40 min is 8 hrs. I would look out for that as a bad sign.

 

[WisNeuro]

It's like I have done this before.

Not sure what the RVU requirements are for the salaried folks where you are. At the other PE owned places I knew of the requirement was 12 sessions of 90834 per day. How did they justify this? 12x40 min is 8 hrs. I would look out for that as a bad sign,.

Probably a combination of overworking their employees and illegally up-billing codes. We have a weird mix in the field. We have the underpaid, overworked people cramming 40+ sessions a week in, and on the other extreme, newer people working 15-20 sessions/week, thinking that they are FT, and whining that they aren't paid well.

 

[quickpsych]

It's like I have done this before.

Not sure what the RVU requirements are for the salaried folks where you are. At the other PE owned places I knew of the requirement was 12 sessions of 90834 per day. How did they justify this? 12x40 min is 8 hrs. I would look out for that as a bad sign.

They utilize a point system. Mostly 90871 and 90833 are used, alongside some occasional 90834.

Last I knew, it ranges in half point increments per service, X points a day. 90791 is 2.5x the value of a 90833 for context. The psychologists mostly do 90871s , the midlevels mostly do 90833 and 90834. Come to think of it I have no idea how they convince midlevels to work for them since they rarely get 90871s and tend to be expected to see 12-18 patients a day.

So basically the psychologists are assessors and data collectors for the facilities and the midlevels are the brief therapy providers.

 

[WisNeuro]

They utilize a point system. Mostly 90871 and 90833 are used, alongside some occasional 90834.

Last I knew, it ranges in half point increments per service, X points a day. 90871 is 2.5x the value of a 90833 for context. The psychologists mostly do 90871s , the midlevels mostly do 90833 and 90834. Come to think of it I have no idea how they convince midlevels to work for them since they rarely get 90871s and tend to be expected to see 12-18 patients a day.

So basically the psychologists are assessors and data collectors for the facilities and the midlevels are the brief therapy providers.

Isn't 90871 a discontinued ECT code?

 

[quickpsych]

Isn't 90871 a discontinued ECT code?

Isn't 90871 a discontinued ECT code?

Good catch, edited my post. Actually meant 90791.

 

[Sanman]

They utilize a point system. Mostly 90871 and 90833 are used, alongside some occasional 90834.

Last I knew, it ranges in half point increments per service, X points a day. 90791 is 2.5x the value of a 90833 for context. The psychologists mostly do 90871s , the midlevels mostly do 90833 and 90834. Come to think of it I have no idea how they convince midlevels to work for them since they rarely get 90871s and tend to be expected to see 12-18 patients a day.

So basically the psychologists are assessors and data collectors for the facilities and the midlevels are the brief therapy providers.

90833? You mean 90832? 90833 is only an adjunct to an E&M code for prescribers. 18 90832s per day is a lot. That is only allotting 26.67 min per session. That is still 7 90791s per day. They are clearing $250k+ per full-time clinician based on Medicare rates.

 

[quickpsych]

90833? You mean 90832? 90833 is only andjuct to an E&M code for prescribers. 18 90832s per day is a lot. That is only allotting 26.67 min per session. That is still 7 90791s per day. They are clearing $250k+ per full-time clinician based on Medicare rates.

Yes I think you’re correct on the code. My bad. And yes when I compared my fee per service to the salary, it kind of made sense to not be salaried. Granted I feel like I work a little harder but I also only work 3 days a week usually by choice so tend to extend my time on site and see a few more patients if there's a need. I know some salaried ones that do 2.5 hrs a day in and out get those points and go home. But company is definitely making bank off them. The midlevels have to work least double that to get their points.

I should consider working a little more but having time is nice too.

I think last I checked the average psychologist salary they were paying was between 110k-118k and average midlevel salary was between 75k-85k although they're advertising full timers can make up to 95k+ a year for midlevels and psychologists up to 145k+ a year when factoring in bonus structures. So they aren't making as much as they could off the salaried folks but definitely a few million a year in pure profits.

 

[Sanman]

Yes I think you’re correct on the code. My bad. And yes when I compared my fee per service to the salary, it kind of made sense to not be salaried. Granted I feel like I work a little harder but I also only work 3 days a week usually by choice so tend to extend my time on site and see a few more patients if there's a need. I know some salaried ones that do 2.5 hrs a day in and out get those points and go home. But company is definitely making bank off them. The midlevels have to work least double that to get their points.

I should consider working a little more but having time is nice too.

I think last I checked the average psychologist salary they were paying was between 110k-118k and average midlevel salary was between 75k-85k although they're advertising full timers can make up to 95k+ a year for midlevels and psychologists up to 145k+ a year when factoring in bonus structures. So they aren't making as much as they could off the salaried folks but definitely a few million a year in pure profits.

Based rough estimates from what you have outlined for full-time folks, they are taking at least 50% of revenue, which is not a good split compared to most private practice groups. You are just working a lot more (and increasing your malpractice risk by churning out patients).

 

[smalltownpsych]

Based rough estimates from what you have outlined for full-time folks, they are taking at least 50% of revenue, which is not a good split compared to most private practice groups. You are just working a lot more (and increasing your malpractice risk by churning out patients).

The bean counters have this stuff down. Sometimes we’re so busy working and trying to help our patients, we get taken advantage of. Unfortunately, good business skills are not part of our core competencies. I advise binge watching shark tank for additional training in this arena.
😁

Seriously though. If the OP can generate 250k a year, then that could pay for a decent office and even a part time admin support and still have a little left over. Set up a little more infrastructure and analyze the market and need and begin bringing others on board and increase revenue. The nice thing about being a psychologist is that we can generate a lot of revenue to get something started with low startup costs. This is the easiest business I ever envisioned starting up.

One reason I encourage psychologists to start their own businesses (besides the obvious narcissistic reason 😎) is that I think we generally do a better job than others less qualified and I am tired of the unethical and inadequate care that our patients get. Part of my business model is to work with people who have had extremely negative treatment experiences so I know first hand what bad treatment can cause.

 

[quickpsych]

Based rough estimates from what you have outlined for full-time folks, they are taking at least 50% of revenue, which is not a good split compared to most private practice groups. You are just working a lot more (and increasing your malpractice risk by churning out patients).

Revenue wise , split sounds about right, definitely lower than most private practice groups but less hours a day in this overall. At least for now.
As for the malpractice risk, I'm under company liability coverage and also carry my own as a back up. Vast majority of patients I see are one off evaluations as many are in sub acute units, and generally just make some general recs or refer to a midlevel; so I generally only have a few caseload patients I see regularly for follow up therapy sessions. Now if I was a midlevel or they made us work huge caseloads like midlevels, yeah I'd reconsider if the risk is worth the pros. Good point.

The bean counters have this stuff down. Sometimes we’re so busy working and trying to help our patients, we get taken advantage of. Unfortunately, good business skills are not part of our core competencies. I advise binge watching shark tank for additional training in this arena.
😁

Seriously though. If the OP can generate 250k a year, then that could pay for a decent office and even a part time admin support and still have a little left over. Set up a little more infrastructure and analyze the market and need and begin bringing others on board and increase revenue. The nice thing about being a psychologist is that we can generate a lot of revenue to get something started with low startup costs. This is the easiest business I ever envisioned starting up.

One reason I encourage psychologists to start their own businesses (besides the obvious narcissistic reason 😎) is that I think we generally do a better job than others less qualified and I am tired of the unethical and inadequate care that our patients get. Part of my business model is to work with people who have had extremely negative treatment experiences so I know first hand what bad treatment can cause.

Oh yeah the bean counters are keen to this. And access to these kind of settings are more and more restricted to if you work for a larger company.

I used to be more into the idea of opening my own practice, but with my personal circumstances and lifestyle I don't know if it's something I'd want to commit that much time and upkeep too. I'm not sure I have the interest or energy to commit to building a private practice to the level you have, but I do respect that it's doable. I have considered maybe a telehealth practice to get back into more traditional services but that's probably down the line as having no set schedule and no set appointment time obligations fits better for me at this time. If I could figure out a way to do some quality general psych and psychoeducational assessments (have been doing periodic per diem ones at a small practice someone else owns for years) over telehealth alongside a few therapy sessions I'd probably at least look into how that might work if feasible.

Out of curiosity @smalltownpsych , how many hours a week do you work running and engaging in your practice business?

 

[smalltownpsych]

Revenue wise , split sounds about right, definitely lower than most private practice groups but less hours a day in this overall. At least for now.
As for the malpractice risk, I'm under company liability coverage and also carry my own as a back up. Vast majority of patients I see are one off evaluations as many are in sub acute units, and generally just make some general recs or refer to a midlevel; so I generally only have a few caseload patients I see regularly for follow up therapy sessions. Now if I was a midlevel or they made us work huge caseloads like midlevels, yeah I'd reconsider if the risk is worth the pros. Good point.


Oh yeah the bean counters are keen to this. And access to these kind of settings are more and more restricted to if you work for a larger company.

I used to be more into the idea of opening my own practice, but with my personal circumstances and lifestyle I don't know if it's something I'd want to commit that much time and upkeep too. I'm not sure I have the interest or energy to commit to building a private practice to the level you have, but I do respect that it's doable. I have considered maybe a telehealth practice to get back into more traditional services but that's probably down the line as having no set schedule and no set appointment time obligations fits better for me at this time. If I could figure out a way to do some quality general psych and psychoeducational assessments (have been doing periodic per diem ones at a small practice someone else owns for years) over telehealth alongside a few therapy sessions I'd probably at least look into how that might work if feasible.

Out of curiosity @smalltownpsych , how many hours a week do you work running and engaging in your practice business?

I am at the office M - T from 9 to 5. Occasionally, I’ll do some work on Fridays. Truth is that I work less now than I did when I was working for others. Prior jobs I was always working 8 to 5 Monday through Friday and had call at times as well. I have made more money in the past, but this year am anticipating exceeding that. The best part is that I am putting effort into growing my business and not someone else who never really appreciates it.

 

[quickpsych]

I am at the office M - T from 9 to 5. Occasionally, I’ll do some work on Fridays. Truth is that I work less now than I did when I was working for others. Prior jobs I was always working 8 to 5 Monday through Friday and had call at times as well. I have made more money in the past, but this year am anticipating exceeding that. The best part is that I am putting effort into growing my business and not someone else who never really appreciates it.

Thank you, I appreciate you taking the time to outline what week in the life of a private practice business owner looks like.

Wish you all the success in growing your business even further!

 

[Therapist4Chnge]

PP is often a lot of planning up front (ideally), and with the right ppl/companies in place, PP can become a nice mix of flexibility, revenue, and periodic headaches. In my first couple years of PP a lot of little things pop up, but that is part of the learning curve. Joining your state association can (often) be helpful bc they usually have some sort of PP group or list serv to give/get info about PP.