F0nzie's Cash Private Practice - The Updates

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keep said:
Thank you so much. Any recommendations for website like where to start and options. I also sent you a PM?
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Sorry, just checked my PMs and didn't see a message.

Several options:

1. Do it yourself. I built several websites during residency before creating the final product. It took me many hours of tinkering around but I enjoyed it. Kinda like how I enjoy taking computers apart and working on my car in the garage. Is it financially worth it? Probably not. If you want to get started on your own, learn some basic html and css and go from there. I should warn you that the internet browsers and platforms are constantly changing. Any glitch or error in your code can cause your entire site to crash. After your site crashes, finding the problem can be like looking for a needle in a haystack. Frequent backups are recommended to protect your site.

2. Some website hosting companies will let you create your own site by using their interface. These platforms will allow you to insert images and text to build a very basic website. Unfortunately your site may look very bland or even unprofessional if you do not know what you are doing.

If you do decide to design your own website, I highly recommend that you get feedback from friends, family, and colleagues before launching.

3. This is probably the best option. Go with a company that offers medical webdesign. Type "medical webdesign" in Google. Check out the portfolios. I would recommend a budget of no more than 3k for the design and 1-2k for yearly maintenance.
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Hey @F0nzie, any major updates? I'm guessing your lack of recent activity is a positive sign of the success of your practice :)
 
InGen said:
Hey @F0nzie, any major updates? I'm guessing your lack of recent activity is a positive sign of the success of your practice :)
Click to expand...

The practice is a win. :) I feel like I can finally let go of any uncertainty. The autonomy is great and venturing into new territory has been an interesting and valuable experience.

Some qualities of the pp which I feel have boosted referrals:

-I answer all calls promptly.

-There are no wait times.

-I communicate with all of my referral sources.

-Follow ups are generally a hour in length.

The practice seems to attract individuals with a combination of axis 1, 2, substance use disorders and many have had a hx of previous treatment. My approach is med management with Psychodynamic, CBT, and Motivational. It's pretty much ideal for me since I am all about therapy. I definitely feel it has been worth all of the time and effort.

I think anybody starting a practice should weigh all the options. Does it fit with your practice style and long term goals in Psychiatry? Do you want more autonomy along with more responsibility? Can you feel ethical not accepting insurance? Do you plan on staying in one location long term as your practice slowly builds? Are you willing to carve out time to meet and work with colleagues in the community to get your practice known? Are you willing to be on call 24/7 including holidays and vacations? Are you willing to take the financial risk of starting a pp knowing that it could fail or not meet your expectations? Do you want to keep track of business expenses and complicate your tax situation? Is now the right time to take financial risks if you have student loan debt and a family to provide for?

Hope this gives you some food for thought. It's a difficult decision to make especially if you can easily land a outpatient med management job for 200k, clock out at 5pm, turn off your phone/pager, get paid time off, call coverage, benefits, etc.

But yea I also haven't been posting as much lately because I have been studying for boards and playing ball with the kiddo. I'm still around though.Thanks for asking! :)
 
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F0nzie said:
The practice is a win. :) I feel like I can finally let go of any uncertainty. The autonomy is great and venturing into new territory has been an interesting and valuable experience.

Some qualities of the pp which I feel have boosted referrals:

-I answer all calls promptly.

-There are no wait times.

-I communicate with all of my referral sources.

-Follow ups are generally a hour in length.

The practice seems to attract individuals with a combination of axis 1, 2, substance use disorders and many have had a hx of previous treatment. My approach is med management with Psychodynamic, CBT, and Motivational. It's pretty much ideal for me since I am all about therapy. I definitely feel it has been worth all of the time and effort.

I think anybody starting a practice should weigh all the options. Does it fit with your practice style and long term goals in Psychiatry? Do you want more autonomy along with more responsibility? Can you feel ethical not accepting insurance? Do you plan on staying in one location long term as your practice slowly builds? Are you willing to carve out time to meet and work with colleagues in the community to get your practice known? Are you willing to be on call 24/7 including holidays and vacations? Are you willing to take the financial risk of starting a pp knowing that it could fail or not meet your expectations? Do you want to keep track of business expenses and complicate your tax situation? Is now the right time to take financial risks if you have student loan debt and a family to provide for?

Hope this gives you some food for thought. It's a difficult decision to make especially if you can easily land a outpatient med management job for 200k, clock out at 5pm, turn off your phone/pager, get paid time off, call coverage, benefits, etc.

But yea I also haven't been posting as much lately because I have been studying for boards and playing ball with the kiddo. I'm still around though.Thanks for asking! :)
Click to expand...

Can you post a link to your website so I can see how it is organized ?
 
F0nzie said:
The practice is a win. :) I feel like I can finally let go of any uncertainty. The autonomy is great and venturing into new territory has been an interesting and valuable experience.

Some qualities of the pp which I feel have boosted referrals:

-I answer all calls promptly.

-There are no wait times.

-I communicate with all of my referral sources.

-Follow ups are generally a hour in length.

The practice seems to attract individuals with a combination of axis 1, 2, substance use disorders and many have had a hx of previous treatment. My approach is med management with Psychodynamic, CBT, and Motivational. It's pretty much ideal for me since I am all about therapy. I definitely feel it has been worth all of the time and effort.

I think anybody starting a practice should weigh all the options. Does it fit with your practice style and long term goals in Psychiatry? Do you want more autonomy along with more responsibility? Can you feel ethical not accepting insurance? Do you plan on staying in one location long term as your practice slowly builds? Are you willing to carve out time to meet and work with colleagues in the community to get your practice known? Are you willing to be on call 24/7 including holidays and vacations? Are you willing to take the financial risk of starting a pp knowing that it could fail or not meet your expectations? Do you want to keep track of business expenses and complicate your tax situation? Is now the right time to take financial risks if you have student loan debt and a family to provide for?

Hope this gives you some food for thought. It's a difficult decision to make especially if you can easily land a outpatient med management job for 200k, clock out at 5pm, turn off your phone/pager, get paid time off, call coverage, benefits, etc.

But yea I also haven't been posting as much lately because I have been studying for boards and playing ball with the kiddo. I'm still around though.Thanks for asking! :)
Click to expand...
Thanks for the updates! Glad to see all your hard work is paying off :claps:
 
Great thread - thanks for being candid about your experience.

Now that the practice is been going for a couple of years now, how much time are you and your wife dedicating to it? I.e., is it still a part-time venture to supplement more "regular" work or have you transitioned to doing the PP full-time? Also, would you mind sharing how you're doing in terms of your gross income (e.g., $/hr on average given your current patient load, waiving/reducing fees, no-shows, etc.)? You can also PM me if you don't want to share that information publicly.

In terms of the child work, do you find that your wife is seeing a lot of younger patients (e.g., <13) or is a lot of the child work more in the adolescent realm?

Congratulations on your success and best of luck.
 
We should be pulling in 125k each this year from the pp. The child/adolescent ratio is 50/50. Been turning off the faucet on the number of referrals we accept. I also work 2 days at a cmhc just to keep it real. With that I have a full day and 2 half days off every week for father-son time. The good life.
 
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F0nzie said:
We should be pulling in 125k each this year from the pp. The child/adolescent ratio is 50/50. Been turning off the faucet on the number of referrals we accept. I also work 2 days at a cmhc just to keep it real. With that I have a full day and 2 half days off every week for father-son time. The good life.
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So $125k for the equivalent of two full days per week?
 
st2205 said:
So $125k for the equivalent of two full days per week?
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More like 2 half days or a little more than 2 half days. I've been getting into the office at around 9:30am and leaving by 3pm. This is excluding all the work that happens behind the scenes to run the business. I like to conveniently omit that. ;) I don't need employers and I don't need boards. Hah! (although doing them for fun).
 
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Thanks for the great thread! Is that 125k before or after overhead?
 
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kirkirkir said:
Thanks for the great thread! Is that 125k before or after overhead?
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This is a ballpark take home amount factoring our necessary overhead. Realistically this number isn't meaningful for anybody. You need to decide what you are going to charge and how much your overhead will be. Are you going to get the fancy 2000 sqft office with the view to the lake or will you get the closet sized windowless office? Will you hire staff or do your own billing, scheduling, calling, accounting, etc? The list goes on and on. The degree of variability is tremendous.

There is risk in this game and you can easily get blinded to where your take home might actually be significantly lower than simply doing contract work. There is a lot of safety in clocking in and out and knowing you are guaranteed $100-$130 an hour. If I hired psychiatrist at a flat hourly rate I could potentially lose a lot of money with cancellations, no shows, and non-payment even if the hourly rate was $300. I have had days where half of my case load or more does not show. The number of new referrals also fluctuates widely depending on the week, the month, season....there can be some huge dead spots.
 
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I just discovered this thread, which is awesome and inspiring. Almost simultaneously, though, I also stumbled upon (simply by Googling "Boston Cash Psychiatrist") found an article/news that was both scary and discouraging: can anyone weigh in, whether in the Boston area or not, about what this center may have done wrong? Thanks!

http://www.bizjournals.com/boston/b...y-says-opioid-treatment-center-cashed-in.html
 
hoya78 said:
I just discovered this thread, which is awesome and inspiring. Almost simultaneously, though, I also stumbled upon (simply by Googling "Boston Cash Psychiatrist") found an article/news that was both scary and discouraging: can anyone weigh in, whether in the Boston area or not, about what this center may have done wrong? Thanks!

http://www.bizjournals.com/boston/b...y-says-opioid-treatment-center-cashed-in.html
Click to expand...

The article pretty much covered the answer to your question...
 
hoya78 said:
I just discovered this thread, which is awesome and inspiring. Almost simultaneously, though, I also stumbled upon (simply by Googling "Boston Cash Psychiatrist") found an article/news that was both scary and discouraging: can anyone weigh in, whether in the Boston area or not, about what this center may have done wrong? Thanks!

http://www.bizjournals.com/boston/b...y-says-opioid-treatment-center-cashed-in.html
Click to expand...
I'm guessing that the clinic/doctor was contracted with the Massachusetts insurance provider "MassHealth" for providing psychiatric care or something like that. Someone in charge of the clinic decided to carve out Suboxone addiction treatment and unilaterally decide they would not accept MassHealth for that particular treatment, but instead would charge $325 cash. The problem is you can't do that (and I would be surprised if anyone really tried to do it this way). . If you're contracted with an insurer you have to see their customers (your patients) and charge the agreed upon rates. A way around this, I think, would be to setup a completely separate business entity that would not accept MassHealth at all, then you could charge the cash rates for Suboxone visits at a different office site. The article isn't that long actually, and is surely lacking details. I wonder if the clinic might have tried to do something like this with an alternate clinic but the attorney general is still trying to take action against them. Attorneys are the worst when they're not your attorney.
 
Great thread! I also recently started a solo cash practice. Any updates as of Aug. 2016?
 
@F0nzie, any updates on your practice? I'm looking back, would you have done anything differently? Looking to start a PP practice part-time in about a year or year and a half.
 
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How many patients do you have now? Are you doing private practice full time? How do you choose which patients you will accept lately? Who is looking after your patients when you are on vacation or out sick?
 
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wolfvgang22 said:
How many patients do you have now? Are you doing private practice full time? How do you choose which patients you will accept lately? Who is looking after your patients when you are on vacation or out sick?
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Good questions. Are you on call 24/7, 365 days per year or do you share after-hours coverage with another psychiatrist?
 
wolfvgang22 said:
How many patients do you have now? Are you doing private practice full time? How do you choose which patients you will accept lately? Who is looking after your patients when you are on vacation or out sick?
Click to expand...

I lost count of the census but I see patients 2.5 days a week. I accept new patients based on my availability. I am on call everyday even when I am on vacation but I am hoping to change this soon.


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Hey Fonzie,
Thanks for starting this thread....would love to hear an update on how things are going now..Are you still at 2.5d a week or have you expanded? How quickly did the C&A pt slots fill compared to your practice?
Thanks for all of your posts!
 
Rangers247 said:
Hey Fonzie,
Thanks for starting this thread....would love to hear an update on how things are going now..Are you still at 2.5d a week or have you expanded? How quickly did the C&A pt slots fill compared to your practice?
Thanks for all of your posts!
Click to expand...

Yes I am still only working part time. No problem filling the C&A slots because my wife only sees them two afternoons a week. Currently looking for a Child Psychiatrist who wants to play with us. :)


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F0nzie said:
Yes I am still only working part time. No problem filling the C&A slots because my wife only sees them two afternoons a week. Currently looking for a Child Psychiatrist who wants to play with us. :)


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Click to expand...

Same problem with my cash-only clinic. Even with excellent pay, I see new graduates prefer PSLF, etc
 
F0nzie said:
Yes I am still only working part time. No problem filling the C&A slots because my wife only sees them two afternoons a week. Currently looking for a Child Psychiatrist who wants to play with us. :)


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Click to expand...

2.5 days/ week looks like a perfect life style!!!
Do you have any other job? Can you still do descent money working part-time?
 
PistolPete said:
@F0nzie and @TexasPhysician How long do you guys feel it would take to fill a cash-only clinic, seeing both adults and children, for two full 10 hour days with evening appointments?
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This is a hard question to answer and is probably very location dependent. I think the barrier to entry in my area is much higher than it was 3 years ago. I have seen new cash practices rise and fall, old cash pps switch to insurance, and new NP privates practice. I have been in private practice for almost 4 years and I am still working towards having more consistent hours and less gaps in my part-time schedule. If you want 20 hrs, you need to shoot for 30 and hope you land on 20. My estimate is 3-5 years or more.



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PistolPete said:
@F0nzie and @TexasPhysician How long do you guys feel it would take to fill a cash-only clinic, seeing both adults and children, for two full 10 hour days with evening appointments?
Click to expand...

Depends on location, price, marketing skills, etc. I've seen people take years to fill 20 hours. My clinic is over 50hrs in 1.5 years.
 
Ahamis said:
2.5 days/ week looks like a perfect life style!!!
Do you have any other job? Can you still do descent money working part-time?
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Yes, I have a child with a disability who is my world :)

The pay is decent but certainly not quick and easy. In the short term I would be better compensated working for someone else.


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Some guy on here a few weeks back tried to sell his practice claiming he was working 40hrs per week and making 500k. Experienced psychiatrists with private practices: is 500-600k per year reasonable working 40 hrs per week or was that guy an anomaly?
 
Merely said:
Some guy on here a few weeks back tried to sell his practice claiming he was working 40hrs per week and making 500k. Experienced psychiatrists with private practices: is 500-600k per year reasonable working 40 hrs per week or was that guy an anomaly?
Click to expand...

500k is not the norm for 40hrs. I believe that poster also mentioned other clinical staff in the practice which increased income.
 
Merely said:
Some guy on here a few weeks back tried to sell his practice claiming he was working 40hrs per week and making 500k. Experienced psychiatrists with private practices: is 500-600k per year reasonable working 40 hrs per week or was that guy an anomaly?
Click to expand...

He was an anomaly....400 k is more reasonable, although I don't doubt that he was making more
 
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