Expected rate of growth of private practice

[Dr.EzE]

Hello community!

I’m an ECP looking to transition into full time private practice. I live in NYC. I will likely accept cash only at avg to a bit less cost than avg psychiatrist. I plan on doing 30min f/u sessions. I plan on advertising with a website and through psychology/therapist search websites.

Can those with their own practice share their growth rate per month?
How many new clients did you get per month?
How many clients did you take into your practice before saying you were full?
How long did it take you to become full?

Thank you on sharing this info. It will help me in calculating my expenses and financial decisions.

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[dl2dp2]

This is really highly variable depending on a lot different factors, and the biggest of which is geography. Few people here practice in NY.

My suggestion is that you reach out to people in your area who has established practices and seek mentorship or through the local professional society such as NYSPA, or people you know who trained. The more you socialize and network, the richer your referral system grows. The biggest error for ECP and small business owners in general is not networking and talking to people when they start out.

 

[wolfvgang22]

I'm just here for the little Thanksgiving hat

 

[TexasPhysician]

Too variable. I’ve seen people open practices that never really build. A few years later and they close shop. Others can build really fast and are slammed within a few months.

 

[Psychresy]

Too variable. I’ve seen people open practices that never really build. A few years later and they close shop. Others can build really fast and are slammed within a few months.

Have you noticed any differences between the two?

 

[dl2dp2]

Have you noticed any differences between the two?

The consistent difference is social skills. People who have practices that fail have various issues with their setup, but the consistent strain I see is that they are unwilling or unable to talk/network to their colleagues to figure out what it is that is necessary to make it work in their market, or what's the missing link.

People who have low social skills or very introverted/narcissistic are bad at being business owners.

That said, many markets are friendly enough that many *successful* practice owners STILL have bad social skills (operationally defined as higher-income/better lifestyle than a facilities-based job). In those markets, people who have social skills often become extraordinarily successful.

 

[Psychresy]

The consistent difference is social skills. People who have practices that fail have various issues with their setup, but the consistent strain I see is that they are unwilling or unable to talk/network to their colleagues to figure out what it is that is necessary to make it work in their market, or what's the missing link.

People who have low social skills or very introverted/narcissistic are bad at being business owners.

That said, many markets are friendly enough that many *successful* practice owners STILL have bad social skills (operationally defined as higher-income/better lifestyle than a facilities-based job). In those markets, people who have social skills often become extraordinarily successful.

Yeah that makes sense. I tend to think I have at least above average social skills so hopefully that bodes well. Any familiarity with west coast markets in terms of "friendliness"?

 

[TexasPhysician]

Have you noticed any differences between the two?

I’d be speculating based on what I know works. Most physicians are poor business-people.

This is just my philosophy below. To me, having a 1 person, single specialty medical practice is a poor business decision. There should be a plan in place day 1 for expansion, regardless of whether you are adding another psychiatrist, counselor, acupuncturist, yoga instructor, pain medicine, PA, or whatever. Depending on your business plan, expansion can take many forms.

With some level of expansion, you can still generate income or at minimum pay your expenses even while you are on vacation. With another physician, you can take vacation without being on call the entire time for refills, concerns, urgent visits, etc.

Expansion also requires you to start thinking more business-like. You likely can’t successfully add an acupuncturist without a plan for how you will fill their hours. You can’t just add - “Now with acupuncture” on your website and generate enough patients. The business plan shouldn’t be - eventually I’ll have enough patients for me.

If you aren’t going to expand and grow a business, don’t start a pp. If you have a niche that you want to fill and don’t want to manage the business, contact some pp psychiatrists and find one that will allow you to practice how you want or find locum gigs that allow it. Enjoy life with your other hours.

 

[dl2dp2]

Yeah that makes sense. I tend to think I have at least above average social skills so hopefully that bodes well. Any familiarity with west coast markets in terms of "friendliness"?

Most markets on the coast metros are fine. Network, be efficient, be willing to be flexible (i.e. work a variety of contexts, go up and down depending on market conditions) and troubleshoot consistently. Set milestones and track them.

To me, having a 1 person, single specialty medical practice is a poor business decision. There should be a plan in place day 1 for expansion, regardless of whether you are adding another psychiatrist, counselor, acupuncturist, yoga instructor, pain medicine, PA, or whatever. Depending on your business plan, expansion can take many forms.

You are 100% right, in GENERAL.

However, psychiatry is somewhat unique in that this is one of the few specialties where you can still be a solopreneur and make 1M a year doing high end cash. Fairly rare, but happens. In many markets, it's *not too hard* to be a solopreneur and make 300k+ and work fewer hours than a typical facility-driven job. If you limit that as a definition of "success", then I think it's less stressful than what you describe.

 

[TexasPhysician]

Most markets on the coast metros are fine. Network, be efficient, be willing to be flexible (i.e. work a variety of contexts, go up and down depending on market conditions) and troubleshoot consistently. Set milestones and track them.



You are 100% right, in GENERAL.

However, psychiatry is somewhat unique in that this is one of the few specialties where you can still be a solopreneur and make 1M a year doing high end cash. Fairly rare, but happens. In many markets, it's *not too hard* to be a solopreneur and make 300k+ and work fewer hours than a typical facility-driven job. If you limit that as a definition of "success", then I think it's less stressful than what you describe.

Take the solopreneur you describe. How many hours were spent managing/reviewing a website, networking, planning advertising, buying furniture, hiring, payroll, accounting, legal correspondence, finding office space, constructing business cards, cleaning services, etc.? The time adds up. For quite some time, the hours aren’t better, just different. The build-up period provides less income than almost anything else. For months to years, it is a bad financial decision.

Take the same person that did all of that successfully. How many incremental hours of effort is it to add 1 additional service that doesn’t require your constant presence? How can you get there?

That mindset greatly increases the odds of success. In no way am I implying that you can’t be “successful” by yourself.

 

[dl2dp2]

Take the solopreneur you describe. How many hours were spent managing/reviewing a website, networking, planning advertising, buying furniture, hiring, payroll, accounting, legal correspondence, finding office space, constructing business cards, cleaning services, etc.? The time adds up. For quite some time, the hours aren’t better, just different. The build-up period provides less income than almost anything else. For months to years, it is a bad financial decision.

Take the same person that did all of that successfully. How many incremental hours of effort is it to add 1 additional service that doesn’t require your constant presence? How can you get there?

That mindset greatly increases the odds of success. In no way am I implying that you can’t be “successful” by yourself.

Agree 100%. It’s a certain independence, driven, growth oriented mindset.

 

[liquidshadow22]

Take the solopreneur you describe. How many hours were spent managing/reviewing a website, networking, planning advertising, buying furniture, hiring, payroll, accounting, legal correspondence, finding office space, constructing business cards, cleaning services, etc.? The time adds up. For quite some time, the hours aren’t better, just different. The build-up period provides less income than almost anything else. For months to years, it is a bad financial decision.

Take the same person that did all of that successfully. How many incremental hours of effort is it to add 1 additional service that doesn’t require your constant presence? How can you get there?

That mindset greatly increases the odds of success. In no way am I implying that you can’t be “successful” by yourself.

how doable is it for an adult cash practice to add the other services you mentioned? - yoga, acupuncture, counselor etc? do those ancillary services fit into a cash model typically?

 

[TexasPhysician]

how doable is it for an adult cash practice to add the other services you mentioned? - yoga, acupuncture, counselor etc? do those ancillary services fit into a cash model typically?

It really depends on your niche and ability to market. I just met an adult psych cash only that has 2 acupuncturists and someone who does sound healing. I don’t want to get off on a tangent regarding the benefits of these services. This psychiatrist really pushes meditation and various coping skills to manage anxiety over benzodiazepines. He doesn’t try to convince people that music cures schizophrenia.

 

[Psychresy]

It really depends on your niche and ability to market. I just met an adult psych cash only that has 2 acupuncturists and someone who does sound healing. I don’t want to get off on a tangent regarding the benefits of these services. This psychiatrist really pushes meditation and various coping skills to manage anxiety over benzodiazepines. He doesn’t try to convince people that music cures schizophrenia.

Do you need to rent a lot of office space to include therapists and maybe a mid level provider? What's something I should look to do from day 1 of starting my pp if adding ancillary services is my goal?

 

[TexasPhysician]

Do you need to rent a lot of office space to include therapists and maybe a mid level provider? What's something I should look to do from day 1 of starting my pp if adding ancillary services is my goal?

Have the space and know your numbers. What is the added cost for each additional office? How much could you generate from their services? How long will it take to fill them? Do the numbers require you to consider alternate locations? How low can you get patient acquisition costs to be? How do you maximize the patient experience at the lowest costs?

 

[Sushirolls]

Growth can vary. Mine is quite slow. I'm approaching end of year 3. General outpatient adult 'med check', insurance based, with 30 min f/u, 90min consults. Me and my part time secretary/assistant. Currently at about ~120patients, and 9 clinical hours per week. Looking like I'll wrap up the year with ~115K in pocket. This rate of growth and income draws the ire of some SDN posters but I consider it success.

I started out with an expansion plan as Texas alludes to, but have since reduced it to likely staying a solo practice. I like the simplicity, less drama, no staff turn over. Do those other admin things Texas allude to add up? You bet. And if you you look at per hour compensation for all the things I do for my current ~115k, this was a horrible financial decision. However, I was burned out on Big Box shop jobs and it was either this or I retreat to being a rancher. So currently I consider my solo practice a success. I'm paying my bills. And growing at a pace that preserves the quality of medicine I want to deliver.

Despite moments of wanting to chase the $ and enter snake oil like the the above example given, I just can't cross that line. And in my market shamanistic things are valued and ever increasing. The number of people choosing NDs as their PCP is mind boggling. Counseling against cannabis comes with direct consequence of negative Google reviews.

Yet, the flexibility of being your own boss and not dealing with Big Box shop scat, is PRICELESS. I consider my practice a success. And when I reflect on the low income at this stage I reflect on the positive, that each quarter, each year my income goes up and limited by my choosing of when I want to say I'm full.

 

[Psychresy]

Growth can vary. Mine is quite slow. I'm approaching end of year 3. General outpatient adult 'med check', insurance based, with 30 min f/u, 90min consults. Me and my part time secretary/assistant. Currently at about ~120patients, and 9 clinical hours per week. Looking like I'll wrap up the year with ~115K in pocket. This rate of growth and income draws the ire of some SDN posters but I consider it success.

I started out with an expansion plan as Texas alludes to, but have since reduced it to likely staying a solo practice. I like the simplicity, less drama, no staff turn over. Do those other admin things Texas allude to add up? You bet. And if you you look at per hour compensation for all the things I do for my current ~115k, this was a horrible financial decision. However, I was burned out on Big Box shop jobs and it was either this or I retreat to being a rancher. So currently I consider my solo practice a success. I'm paying my bills. And growing at a pace that preserves the quality of medicine I want to deliver.

Despite moments of wanting to chase the $ and enter snake oil like the the above example given, I just can't cross that line. And in my market shamanistic things are valued and ever increasing. The number of people choosing NDs as their PCP is mind boggling. Counseling against cannabis comes with direct consequence of negative Google reviews.

Yet, the flexibility of being your own boss and not dealing with Big Box shop scat, is PRICELESS. I consider my practice a success. And when I reflect on the low income at this stage I reflect on the positive, that each quarter, each year my income goes up and limited by my choosing of when I want to say I'm full.

Any idea how much adding a single NP or therapist can add to a practice?

 

[Ole_Toe]

Growth can vary. Mine is quite slow. I'm approaching end of year 3. General outpatient adult 'med check', insurance based, with 30 min f/u, 90min consults. Me and my part time secretary/assistant. Currently at about ~120patients, and 9 clinical hours per week. Looking like I'll wrap up the year with ~115K in pocket. This rate of growth and income draws the ire of some SDN posters but I consider it success.

I started out with an expansion plan as Texas alludes to, but have since reduced it to likely staying a solo practice. I like the simplicity, less drama, no staff turn over. Do those other admin things Texas allude to add up? You bet. And if you you look at per hour compensation for all the things I do for my current ~115k, this was a horrible financial decision. However, I was burned out on Big Box shop jobs and it was either this or I retreat to being a rancher. So currently I consider my solo practice a success. I'm paying my bills. And growing at a pace that preserves the quality of medicine I want to deliver.

Despite moments of wanting to chase the $ and enter snake oil like the the above example given, I just can't cross that line. And in my market shamanistic things are valued and ever increasing. The number of people choosing NDs as their PCP is mind boggling. Counseling against cannabis comes with direct consequence of negative Google reviews.

Yet, the flexibility of being your own boss and not dealing with Big Box shop scat, is PRICELESS. I consider my practice a success. And when I reflect on the low income at this stage I reflect on the positive, that each quarter, each year my income goes up and limited by my choosing of when I want to say I'm full.

Even from a financial perspective 115k for 9 clinical hours per week is excellent. Of course this doesn’t count the admin time as a business owner but hopefully that time investment will pay dividends. At the very least it sounds like it’s been an enjoyable learning experience and you’ve shared a lot of that knowledge through your postings on here

 

[Sushirolls]

Any idea how much adding a single NP or therapist can add to a practice?

NP with current patient inflow would be of no value and only serve to bog me down with more admin. Plus I'm not interested in supervising a midlevel.

However, a therapist could be value added as they are all full and booked in my area. Definitely an option to consider for future expansion. Still something I'm considering but will wait a few years before doing so.

 

[Sushirolls]

Even from a financial perspective 115k for 9 clinical hours per week is excellent. Of course this doesn’t count the admin time as a business owner but hopefully that time investment will pay dividends. At the very least it sounds like it’s been an enjoyable learning experience and you’ve shared a lot of that knowledge through your postings on here

End of January I'll post a more formal lengthy Year Three summary with all sorts of numbers.

 

[brazilianpsych]

I have to admit that I'm surprise by Sushirolls slow growth, I would assume accepting insurance would make the process faster. Happy to hear it keeps improving and I hope it will only trend up.

 

[rjs2131]

Also fairly surprised with @Sushirolls growth but it sounds like you're doing well relative to hours worked and like your setup, which is really what matters in the end!

To add to how variable this can be - I joined an established PP over summer, and now at the beginning of month 5, I'm full (30 clinical hrs/week of new pts + follow-ups) through the end of the year. 90 min news, 30 min follow-ups. We do take 3-4 insurances but I think other helpful factors have been creating a psychologytoday profile (did this my first week) and contacting local pediatricians/therapists (sending letters, meeting with therapy groups over zoom). Also, joining an established practice can be a great way to jump into the PP world without having to build everything from the ground up.

I've also noticed that psychiatrists who tend to be more personable/friendly seem to thrive in PP (which makes sense...people are generally less willing to pay to see someone they dislike/don't trust).

 

[Ole_Toe]

Also fairly surprised with @Sushirolls growth but it sounds like you're doing well relative to hours worked and like your setup, which is really what matters in the end!

To add to how variable this can be - I joined an established PP over summer, and now at the beginning of month 5, I'm full (30 clinical hrs/week of new pts + follow-ups) through the end of the year. 90 min news, 30 min follow-ups. We do take 3-4 insurances but I think other helpful factors have been creating a psychologytoday profile (did this my first week) and contacting local pediatricians/therapists (sending letters, meeting with therapy groups over zoom). Also, joining an established practice can be a great way to jump into the PP world without having to build everything from the ground up.

I've also noticed that psychiatrists who tend to be more personable/friendly seem to thrive in PP (which makes sense...people are generally less willing to pay to see someone they dislike/don't trust).

Would you mind explaining how earnings work when joining an estabished PP? This forum has great resources for starting your own practice, but I haven't seen as much discussion about joining an established practice. Are you salaried, or is your income production based? Do they decide what you can charge per hour - and what is the amount of overhead typically taken out by the practice? I know that in surgical sub specialties (e.g., ophtho), the big earnings come with partnership as a business owner. Is this similar to psychiatry PP?

Edit: Using the old search function: Pros/Cons to joining a private practice right out of training

joining private group practice

I'm in my final year of training and in middle of job search, was wondering if anyone can give me advice. I'm looking into different jobs (academic hospital, community clinic, VA, state facility etc) I mostly want to do outpatient but given that I have to stay in suburb of NYC due to other...

forums.studentdoctor.net

 

[rjs2131]

Would you mind explaining how earnings work when joining an estabished PP? This forum has great resources for starting your own practice, but I haven't seen as much discussion about joining an established practice. Are you salaried, or is your income production based? Do they decide what you can charge per hour - and what is the amount of overhead typically taken out by the practice? I know that in surgical sub specialties (e.g., ophtho), the big earnings come with partnership as a business owner. Is this similar to psychiatry PP?

Edit: Using the old search function: Pros/Cons to joining a private practice right out of training

joining private group practice

I'm in my final year of training and in middle of job search, was wondering if anyone can give me advice. I'm looking into different jobs (academic hospital, community clinic, VA, state facility etc) I mostly want to do outpatient but given that I have to stay in suburb of NYC due to other...

forums.studentdoctor.net

Sure! I will say this is also incredibly variable and I interviewed/looked into several groups before settling on one. Most private practice groups will offer you a percentage of what you bring in (though some may start you off with a guaranteed base salary your first year). The general theme is that you should expect to make less your first year of PP than you would joining a hospital system/established organization/etc. Not always true, but big box shops will aim to fill you up quickly and tend to emphasize volume. You also have much less control when you join a bigger organization as they tend to standardize things like appointment times, $/RVU, etc.

Here are important variables you should look at/understand (in my opinion - I may be missing some things but this is what was important to me):

1) Cash rate (or if insurance-based, what the average negotiated rate is for a given CPT code)
- This ends up being more important than the actual percentage you take, because if a practice is charging less and/or hasn't negotiated rates that are as strong as other practices in the area, a higher percentage take-home doesn't necessarily mean more money for you. In my experience, a larger, well-established PP has more negotiating power than a solo/smaller PP

2) Percentage you take home
- This varied from 50-75% in my experience, but again a lot of variables go into this. The practice that is offering a 70-75% take-home may not fill you as quickly/may not offer as many other benefits.

3) Other MD's/retention rate
- This is important regardless of the setting, but if a practice/group doesn't have MD's who have been there for at least a few years, you should wonder why. A PP that has MD's who have been there for several years reflects a sustainable work environment. It also usually means people are content with how much they are making and don't feel the need to go elsewhere. Also good to know how often partners/MD's are communicating (i.e. are there regular meetings to discuss the practice/possible changes/upkeep?)

4) Office/admin staff
- Consistent/happy staff = good work environment; in a PP, these are usually the people you interact with more regularly so I would be sure to meet at least the office manager/RN/front desk staff. Your ability to fill your schedule is often related to who is fielding calls/requests for new intakes.

5) CPT Coding
- This is more of a general thing, but if you are looking at insurance-based practices you should know how other MD's code and how you expect to code. There is a substantial (50-100k/year or more usually) difference between someone who is coding 99213's for every follow-up vs 99214+90833. Understand how people at a practice are coding and why.

6) Variables you control
- Outside of all of the above, many PP's allow you to charge for things like missed appointments/no shows, refills, letters, etc. Some may also let you decide how much you charge for a new pt vs follow-up.

7) Partnership
- Again, variable with each practice but an ideal PP situation should allow you to eventually become a "partner" - this might just mean you have access to the books, but if a practice is profitable/running well this should also mean some kind of bonus at the end of the year between partners +/- other benefits that not all employees have access to.

As a new grad/ECP it would also be helpful to know what type of supervision you might receive and whether or not you have access to more experienced MD's.

 

[calvnandhobbs68]

Also fairly surprised with @Sushirolls growth but it sounds like you're doing well relative to hours worked and like your setup, which is really what matters in the end!

To add to how variable this can be - I joined an established PP over summer, and now at the beginning of month 5, I'm full (30 clinical hrs/week of new pts + follow-ups) through the end of the year. 90 min news, 30 min follow-ups. We do take 3-4 insurances but I think other helpful factors have been creating a psychologytoday profile (did this my first week) and contacting local pediatricians/therapists (sending letters, meeting with therapy groups over zoom). Also, joining an established practice can be a great way to jump into the PP world without having to build everything from the ground up.

I've also noticed that psychiatrists who tend to be more personable/friendly seem to thrive in PP (which makes sense...people are generally less willing to pay to see someone they dislike/don't trust).

Yeah similarly I’ve been practice about 4 months now and I’ll hit 200 intakes this week. Not all of those patients are going to be long term patients of course but probably about 90%+ of them are. I’m actually limiting myself by only taking 3 new intakes a day at this point and I’m pretty sure I’m booked intake wise for the rest of the month. On 5 insurance panels but I think 3 of them make up the bulk of my patients.

So just from my experience I would also expect to fill much faster taking insurance. I will say it was slower going at first than I expected but as PCPs/therapists realize you’re pretty open (can get people in sooner than 3-6 months like every other full practice in the area) and get good feedback from patients, they start referring more people your way.

 

[vpsych]

Today marks my 5th month of private practice after getting out of residency and I currently have about 250 clients. My practice is mostly private insurance based.

 

[liquidshadow22]

Today marks my 5th month of private practice after getting out of residency and I currently have about 250 clients. My practice is mostly private insurance based.

That is a very fast ramp up. What payors are you participating with? Did you do any marketing? Do you rx controlled subs?

 

[vpsych]

That is a very fast ramp up. What payors are you participating with? Did you do any marketing? Do you rx controlled subs?

All the major payers including BCBS, IHA, United, Univera, Medicare, etc. Only marketing I did involved putting an ad in a local publication for two months. The most effective means of getting referrals for me has been from networking with local PCPs, neurologists, and psychologists… the flood gates opened once they found out there’s a new shrink in town. Some I knew personally but for the most part it was just a matter of letting them know I exist.

I do prescribe controlled substances when indicated. Currently not involved in writing suboxone or cannabis.

 

[liquidshadow22]

All the major payers including BCBS, IHA, United, Univera, Medicare, etc. Only marketing I did involved putting an ad in a local publication for two months. The most effective means of getting referrals for me has been from networking with local PCPs, neurologists, and psychologists… the flood gates opened once they found out there’s a new shrink in town. Some I knew personally but for the most part it was just a matter of letting them know I exist.

I do prescribe controlled substances when indicated. Currently not involved in writing suboxone or cannabis.

Do you think Medicare was a good decision. Many on here feel its not worth the hassle. Are you satisfied with you commercial rates? Are you in person?

 

[Psychresy]

Today marks my 5th month of private practice after getting out of residency and I currently have about 250 clients. My practice is mostly private insurance based.

How much do your better paying panels pay as compared to medicare (ballpark)?

 

[vpsych]

Do you think Medicare was a good decision. Many on here feel its not worth the hassle. Are you satisfied with you commercial rates? Are you in person?

Yeah I don’t mind taking Medicare, thus far.
I’d say about 95% of my visits are in person.

I’ve been satisfied with commercial rates which pay about $135 for 99213 and $175 for 99214 - @Psychresy

I work in upstate NY

 

[liquidshadow22]

Yeah I don’t mind taking Medicare, thus far.
I’d say about 95% of my visits are in person.

I’ve been satisfied with commercial rates which pay about $135 for 99213 and $175 for 99214 - @Psychresy

I work in upstate NY

are you not including 90833 add on codes in the those numbers? That's really good if not

 

[vpsych]

are you not including 90833 add on codes in the those numbers? That's really good if not

Nope, those are the numbers. They’re on the higher end I’d say, a couple of them pay 99214s closer to $150.

 

[jbomba]

Nope, those are the numbers. They’re on the higher end I’d say, a couple of them pay 99214s closer to $150.

Wow that's amazing. Throw in a 90833 and you're averaging $400+ an hour.

 

[liquidshadow22]

Wow that's amazing. Throw in a 90833 and you're averaging $400+ an hour.

a few of those plans look very specific to upstate new york. i think there is a dearth of mental health providers there

 

[jbomba]

a few of those plans look very specific to upstate new york. i think there is a dearth of mental health providers there

Perhaps but isnt a 99214 like 135 for medicare? The plan paying 150 isnt far above that.

 

[NickNaylor]

A couple of buddies and I are in the early stages of thinking of starting an insurance-based practice. The goal would be to build the practice rapidly, make heavy use of APPs, and, ideally, sell the practice to a larger healthcare system - something that has occurred with some regularity for larger practices in our area. In our initial research, here are issues that we've identified with most smaller psychiatry practices:

1) The customer experience sucks. Websites are useless, practices don't make use of increasingly standard online-based tools, and clinics don't run on time. Patients don't feel like they're being heard in their visits. Many quickly bail to find something different. A lot of small practices are just unpolished, and while that kind of thing shouldn't matter, it does.

2) Physicians don't invest in networking or actively working to increase their referral base. Those that do seem to have no problem building their patient base.

3) As others have mentioned, most practices don't seem to have growth as a primary goal from the beginning or aren't particularly invested in expanding. Practices seem to hamper their own growth by being uninterested/unwilling/unable to invest in the infrastructure necessary to sustain continued growth - whether that be hiring staff, investing in physical infrastructure, or other issues. In this area, insurance-based practices have the ability to fill extremely quickly, but a lot of practices don't seem to grow despite that need. I imagine that, in many/most cases, this is an explicit choice.

4) Owners may not have the financial resources available to continue to fund growth. Hiring, paying benefits, etc. is all expensive, and the cost of that growth has to be accounted for.

I'm sure the issues are different in every geographic area depending on local market conditions, but at least in my area, these seem to be big contributors to practices not growing as rapidly as they could.

 

[calvnandhobbs68]

3) As others have mentioned, most practices don't seem to have growth as a primary goal from the beginning or aren't particularly invested in expanding. Practices seem to hamper their own growth by being uninterested/unwilling/unable to invest in the infrastructure necessary to sustain continued growth - whether that be hiring staff, investing in physical infrastructure, or other issues. In this area, insurance-based practices have the ability to fill extremely quickly, but a lot of practices don't seem to grow despite that need. I imagine that, in many/most cases, this is an explicit choice.

So I think this is the major "issue"...my impression is that many psychiatrists are simply uninterested in expanding and this is an explicit choice. They're perfectly content with being a 1-2 person operation and working 4 days a week. And why shouldn't they? You can make a pretty good living doing that and that's the reason a lot of them are doing private practice. If you don't care about maximizing income, you can make a good 200K+ with a full 3.5 day workweek.

Insurance based practices should grow extremely quickly. Even cash practices are often pretty full after a few years, just more slowly. The demand is there. Often if they are not growing, it's a matter of not actually publicizing they exist, not trying to get a referral base, etc. Nobody knows if you're there if you're not letting people know you're there if you're a small operation. I mean for reference I'm going to have 43 new intakes just for the month of December (and I'm not working 2.5 days this month because of the holidays) and that's because I'm limiting myself to 3 intakes a day max.

 

[Sushirolls]

A couple of buddies and I are in the early stages of thinking of starting an insurance-based practice. The goal would be to build the practice rapidly, make heavy use of APPs, and, ideally, sell the practice to a larger healthcare system - something that has occurred with some regularity for larger practices in our area. In our initial research, here are issues that we've identified with most smaller psychiatry practices:

1) The customer experience sucks. Websites are useless, practices don't make use of increasingly standard online-based tools, and clinics don't run on time. Patients don't feel like they're being heard in their visits. Many quickly bail to find something different. A lot of small practices are just unpolished, and while that kind of thing shouldn't matter, it does.

2) Physicians don't invest in networking or actively working to increase their referral base. Those that do seem to have no problem building their patient base.

3) As others have mentioned, most practices don't seem to have growth as a primary goal from the beginning or aren't particularly invested in expanding. Practices seem to hamper their own growth by being uninterested/unwilling/unable to invest in the infrastructure necessary to sustain continued growth - whether that be hiring staff, investing in physical infrastructure, or other issues. In this area, insurance-based practices have the ability to fill extremely quickly, but a lot of practices don't seem to grow despite that need. I imagine that, in many/most cases, this is an explicit choice.

4) Owners may not have the financial resources available to continue to fund growth. Hiring, paying benefits, etc. is all expensive, and the cost of that growth has to be accounted for.

I'm sure the issues are different in every geographic area depending on local market conditions, but at least in my area, these seem to be big contributors to practices not growing as rapidly as they could.

Well you have declared you have the answers.

Now go open up a practice and see if your survey of the local area pans out.

Start a similar thread as mine and give the ol' SDN land play by play updates.

 

[Merovinge]

A couple of buddies and I are in the early stages of thinking of starting an insurance-based practice. The goal would be to build the practice rapidly, make heavy use of APPs, and, ideally, sell the practice to a larger healthcare system - something that has occurred with some regularity for larger practices in our area. In our initial research, here are issues that we've identified with most smaller psychiatry practices:

1) The customer experience sucks. Websites are useless, practices don't make use of increasingly standard online-based tools, and clinics don't run on time. Patients don't feel like they're being heard in their visits. Many quickly bail to find something different. A lot of small practices are just unpolished, and while that kind of thing shouldn't matter, it does.

One of the main factors I find in patients finding the experience sucks are undertrained and underinformed providers who are not able to discuss the pt's concerns with any convincing degree of medical knowledge. I will admit simply having long appointments helps tremendously w/ rapport but I cannot tell you how many consultations I do that start with "it's so nice to finally speak to a real doctor". I do about 6-8 consults per week and hear this 1-2x weekly on the regular. Even in the past year, when I ask who is someone's outpatient doctor, I routinely hear people say "xyz is my NP or PA, I think they might work under Dr. blah blah".

If you're looking for any feedback, I would anticipate "heavy use of APPs" to be less amazing for your patients than you might anticipate, quality control is particularly tough in that group of employees.

 

[NickNaylor]

One of the main factors I find in patients finding the experience sucks are undertrained and underinformed providers who are not able to discuss the pt's concerns with any convincing degree of medical knowledge. I will admit simply having long appointments helps tremendously w/ rapport but I cannot tell you how many consultations I do that start with "it's so nice to finally speak to a real doctor". I do about 6-8 consults per week and hear this 1-2x weekly on the regular. Even in the past year, when I ask who is someone's outpatient doctor, I routinely hear people say "xyz is my NP or PA, I think they might work under Dr. blah blah".

If you're looking for any feedback, I would anticipate "heavy use of APPs" to be less amazing for your patients than you might anticipate, quality control is particularly tough in that group of employees.

I agree that APP quality can be very valuable, but there are excellent APPs out there. The key is trying to weed out the bad ones from the good ones and providing adequate supervision. We plan to actually supervise APPs that we hire, not "supervise" them for the purposes meeting the necessary legal obligations.

I'm generally quite skeptical of APPs, but I do think they can be effectively utilized in the right circumstances. APPs also make scaling a largely practice much more feasible financially.

 

[Psychresy]

I agree that APP quality can be very valuable, but there are excellent APPs out there. The key is trying to weed out the bad ones from the good ones and providing adequate supervision. We plan to actually supervise APPs that we hire, not "supervise" them for the purposes meeting the necessary legal obligations.

I'm generally quite skeptical of APPs, but I do think they can be effectively utilized in the right circumstances. APPs also make scaling a largely practice much more feasible financially.

Planning to start a pp right out of residency and have eyes on scaling with an app. Any idea how much a single provider could add to my bottom line? Any info or resources you could point me to about the practical stuff; i.e. Do I need to provide them benefits, etc

 

[NickNaylor]

Planning to start a pp right out of residency and have eyes on scaling with an app. Any idea how much a single provider could add to my bottom line? Any info or resources you could point me to about the practical stuff; i.e. Do I need to provide them benefits, etc

Based on our very rough, back-of-the-envelope calculations, all-in we expect that an APP could bring in at least $20-25k/year of profit (which includes paying slightly above market rates). Whether or not you offer benefits will depend on your market and regulatory requirements.

 

[liquidshadow22]

Based on our very rough, back-of-the-envelope calculations, all-in we expect that an APP could bring in at least $20-25k/year of profit (which includes paying slightly above market rates). Whether or not you offer benefits will depend on your market and regulatory requirements.

That's terrible if in fact true. Why bother at all with a mid level if that's all they bring in.

 

[TexasPhysician]

Based on our very rough, back-of-the-envelope calculations, all-in we expect that an APP could bring in at least $20-25k/year of profit (which includes paying slightly above market rates). Whether or not you offer benefits will depend on your market and regulatory requirements.

You missing a 0 on this? $25k/year isn’t worth doing is it?

 

[jbomba]

That's terrible if in fact true. Why bother at all with a mid level if that's all they bring in.

This sounds low to me too.

And when you guys are opening up pp and planning to bring on an NP or two, do you look for office space with the extra rooms from the getgo? Or do you still shoot for a single office and just share hours?