Going solo

[jiggabot]

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How difficult is it to start a solo practice in a big city such as LA or San Fran when compared to starting in a smaller city?

I know most specialties are paid less in bigger cities, but is the same true for private practice psychiatrists? (As larger cities have wealthier people, but more competition...)

 

[nitemagi]

3 words. Location, location, location.

 

[jiggabot]

yes...location is important, but that doesn't answer the question, 🙂

 

[nitemagi]

True. I suspect the reason you're not getting any answers is because your question is a bit vague. Kinda like someone asking "so how hard is it to get into a top 20 med school?" A real answer would be pages long, and even then wouldn't answer the question for your specific situation.

Yes, many cities are more saturated with mental health providers.
If you're industrious, entrepreneurial, and good at networking, I'm sure it can be done in most cities (plus if you actually know what you're doing). Reputation/word of mouth builds practices. Or so I'm told.

 

[whopper]

A lot is going to depend on specific locality. Some sections of LA maybe screaming for a psychiatrist while others could be bloated. Unless you're in the area or know someone there, or someone from there posts here, I don't think any of us could be of much help.

In general, I've noticed that psychiatrists tend to clump in bigger cities, hence that's probably why they earn less pay there. Is this true for all large cities? I'm sure there's some exception to the rule.

I've also noticed that private psychiatrists can command large fees in big cities, but if that's the case, the psychiatrist has to be offering something special that puts him/her above the others.

 

[Manicsleep]

As has been posted above...you are way to vague. Not only is that not going to get you answers on the forum, its a very poor way to enter solo practice. You need to have a plan.

I will give you some basics. The general rules in the beginning would be, get a moonlighting job or a locums job part time. Start a cash only practice and keep overhead low. Get a basic EMR like practice fusion or something and get a local billing agency or do billing online. Go talk to internists and FPs who are in private practice (or pediatricians if thats your thing).

 

[Chimed]

A lot is going to depend on specific locality. Some sections of LA maybe screaming for a psychiatrist while others could be bloated. Unless you're in the area or know someone there, or someone from there posts here, I don't think any of us could be of much help.

In general, I've noticed that psychiatrists tend to clump in bigger cities, hence that's probably why they earn less pay there. Is this true for all large cities? I'm sure there's some exception to the rule.

I've also noticed that private psychiatrists can command large fees in big cities, but if that's the case, the psychiatrist has to be offering something special that puts him/her above the others.

What would be an example?

 

[Manicsleep]

What would be an example?

Things I have seen,

Sleep
Forensics
Eating disorders
Sexual Disorders
ECT/TMS
Published on a topic with academic affiliation: Anxiety, mood disorders etc.
Psychoanalysis...lots of these
Different kinds of therapy
I know someone trying to start a group of Chief Residents only in order to bill themselves as an elite practice. Sort of boutique psychiatry practice. I think their goal is to eventually have only Chiefs or AOA members (or both obviously).
Triple boarded
AOA

Many times people have more than one of these things...they often do actually.

 

[Chimed]

Things I have seen,

Sleep
Forensics
Eating disorders
Sexual Disorders
ECT/TMS
Published on a topic with academic affiliation: Anxiety, mood disorders etc.
Psychoanalysis...lots of these
Different kinds of therapy
I know someone trying to start a group of Chief Residents only in order to bill themselves as an elite practice. Sort of boutique psychiatry practice. I think their goal is to eventually have only Chiefs or AOA members (or both obviously).
Triple boarded
AOA

Many times people have more than one of these things...they often do actually.

Thanks.

So, do folks go into private practice and just see a certain patient population such as anxiety or mood disorders?

 

[whopper]

Just as mentioned above.

My wife, for example, goes to an Ob-Gyn that has a niche market. He actually talks to his patients, educates them, and lets them decide what to do based the pros and cons. He will of course make recommendations but goes out of his way to make the person feel comfortable and in control.

Oh geez, so this guy has a niche because he's actually doing what he's supposed to be doing?

Anyways, you guys know what I'm talking about. It's a shame that this guy has a niche for the above reasons, but this is the very type of thing that can lead patients to a particular doctor over others.

In general, you have to offer something other doctors don't and/or have a reputation with solid backing to convince a patient to see you more so than the other guy.

 

[Chimed]

Just as mentioned above.

My wife, for example, goes to an Ob-Gyn that has a niche market. He actually talks to his patients, educates them, and lets them decide what to do based the pros and cons. He will of course make recommendations but goes out of his way to make the person feel comfortable and in control.

Oh geez, so this guy has a niche because he's actually doing what he's supposed to be doing?

Like you said, doen't seem like a niche--just being a good doc.

In general, you have to offer something other doctors don't and/or have a reputation with solid backing to convince a patient to see you more so than the other guy.

So, my research could possibly help me make a name for myself if I decided to jump into private practice rather then academics? 😎

 

[Manicsleep]

Thanks.

So, do folks go into private practice and just see a certain patient population such as anxiety or mood disorders?

I doubt that they do that exclusively but I think it makes up a large percentage of their population.