Having a private practice as an academic psychiatrist?

[DocMom1]

I have heard that some of the psychiatrists at my academic hospital who are assistant or associate professors have separate private practices where they see private patients. Is this generally allowed in psychiatry?

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[clausewitz2]

I have heard that some of the psychiatrists at my academic hospital who are assistant or associate professors have separate private practices where they see private patients. Is this generally allowed in psychiatry?

Depends on the details of your contract. Many places allow you to do this and might even let you use your office and their EMR but take a sizable cut of your revenue. It's not that unusual though

 

[TexasPhysician]

Highly dependent on the institution. Most near me do not allow you to work in medicine anywhere else. If you really want to moonlight elsewhere, they require the agency to pay them and then the institution will give you a cut of what you earned.

 

[dl2dp2]

I think a better way to say this is no in general it's not allowed as a typical full time W2 staff physician. In specific situations there are specific ways to to do this, typically involving your academic affiliation being a voluntary one--i.e. you are not being paid by the academic institution per se, but retain a courtesy title. Or, the psychiatrists are employed on a part time locum by the hospital.

 

[michaelrack]

Academic psych docs used to be able to have side private practices, but this arrangement is dying out

 

[dl2dp2]

Academic psych docs used to be able to have side private practices, but this arrangement is dying out

One reason is that academic hospitals realized that cash paying PP is a gravy train so they decided that they want to absorb all the cash paying faculty's practices into a "faculty practice group", which takes a cut of your cash revenue in exchange for what they perceive as amenities. What happens of course is that the supply of insurance-taking hospital facilities dwindle. It's a form of consolidation of healthcare--with its predictable consequences, which is that cost goes UP in the end, not down.

 

[tr]

Institution dependent. Different institutions are at different points on the transition from no-regulation through prohibition of outside cash private practice (enforced or not to varying degrees) to subsuming all faculty cash private practices into an official institutional 'faculty practice' where the institution takes a cut.

 

[psychacad]

Highly dependent on the institution. Most near me do not allow you to work in medicine anywhere else. If you really want to moonlight elsewhere, they require the agency to pay them and then the institution will give you a cut of what you earned.

Crazy. Any thoughts why that is the case? You'd think with the financial pressures already there to dissuade budding physician-researchers from pursuing academia, they would be more flexible with their arrangements.

Any thoughts about which institutions tend to be more flexible?

 

[dl2dp2]

Crazy. Any thoughts why that is the case? You'd think with the financial pressures already there to dissuade budding physician-researchers from pursuing academia, they would be more flexible with their arrangements.

Any thoughts about which institutions tend to be more flexible?

This is not the issue. I would think of this as you as an individual has a certain market value. It can either be captured in a faculty position 100% W2, or as some combination of roles inside or outside of academia. Not having non-compete covenants represents part of the compensation package. Institutions that are "more flexible" typically have lower and unstable base salaries. Allowing for outside activities is a compensatory behavior rather than a perk.

Another example of this is federal/state jobs typically allow for outside private practice work, as a form of compensation of their regulatory salary cap, and that state/federal have no competing interest in the group of patients you are taking in PP. Whereas, private non-profit or small group practices have much stricter non-competes. Why would a private group encourage behavior such that you can both work for them and compete against them at the same time? And yet, at the same time, your total comp is typically higher at a private group as a partner. This effect is less pronounced in psychiatry but the gestalt is there.

 

[whopper]

All the above. Some places will force you to not work outside their department, or if you do the department takes in a scoop of your earnings. It all depends on the department.

As bad as this may sound some departments offer enough side work for this not to be an issue at all.

 

[tr]

As bad as this may sound some departments offer enough side work for this not to be an issue at all.

Yes good point, if you need more money it's much more lifestyle friendly to cover inpatient or c/l for the weekend at a frequency that works for you with no strings attached, vs keeping a stable of private practice patients who expect attention at all hours.

 

[NickNaylor]

My institution is of the type @TexasPhysician describes which makes any outside work essentially impossible. We have a PED at our sister public hospital which provides opportunities to moonlight, although given a choice I would work more if I could.

It's a frustrating arrangement. Makes it difficult to, for example, do something like psychoanalytic training as you have no ability to see patients in the institution clinic (because the patient will be billed through their insurance or be forced to pay the ridiculous cash rate) and it's completely infeasible to see patients in your own clinic in return for CME money.

 

[DocMom1]

For departments that do not allow side private practice, do they allow expert-witness or consultative work?

 

[TexasPhysician]

For departments that do not allow side private practice, do they allow expert-witness or consultative work?

No

 

[splik]

For departments that do not allow side private practice, do they allow expert-witness or consultative work?

It will depend on the department. But it is very common for academic faculty to do expert witness and consulting work. Many institutions will consider this distinct from clinical work which would be in direct competition with the institution. Typically you will have to clearance to do any specific work (either before doing it, or else annually reporting all work done) and then the university will have different ways of dealing with this financially:
1. They will take all of the money.
2. They will allow you to keep all the money as long as you don't use university time or resources.
3. They will take a % of the money ranging from 10-50% depending on the institution.
4. They will allow you to keep up to $x per year, and then the rest will be turned over the compensation plan and anything above x, the university will take a cut typically ranging between 10-50%
Consulting work will scrutinized for conflicts of interest especially consulting to pharmaceutical industry, biotech, tech or other for profit industries. Being on the board of companies etc will also require approval.

There can be a lot of bureaurcracy. some policies will be set at the departmental level, whereas others will be at the instutitional level (i.e. the dean's office will have to approve any such work). I ask about these things up front since medicolegal and consulting work is a significant chunk of my income. In my experience, most top academic departments do allow this work even if they forbid clinical private practice. In fact, allowing this kind of working and touting your faculty appointment is considered compensation in kind to make up for the low salaries. A faculty member at one institution told me when they asked for a raise from the chair, they were told to increase their expert witness fee instead.

 

[Username2015]

Some institutions prohibit external work above certain levels of FTE. So if you are full time, you can’t do outside work. But if you are part time / intermittent, outside work is allowed.

 

[NickNaylor]

For departments that do not allow side private practice, do they allow expert-witness or consultative work?

Obviously every institution's policies will be different. I'm currently doing expert witness work on the side, and because of my institution's policy above, I have to remit all of the money that I receive in payment which gets returned to me at ~50% of what I was paid in the form of CME money. So in my case, no, there is no difference. All outside professional work is treated the same and subject to the same rules.

What @Username2015 mentions above is true in my case: these rules apply only for faculty that receive a 100% FTE position (i.e., true full-time). Anything less than 100% and these rules don't apply.