How long did it take to fill your insurance based practice?

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yanks26dmb

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As the title says, residency graduation is fast approaching and I'm planning to start private practice. Aiming to fill 20 hours a week. I'm going to be in a large metropolitan area in California.

I imagine geography matters, but if I were to get on a couple of the best paying panels, any idea how long I might expect to wait to fill those 20 hours? Assume no major bottle neck in terms of my ability to see new intakes..I could realistically do 5-6 per day.

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Is that area saturated? If you take insurance, your practice in my metro area would be filled out for months in less than a few weeks. The only people who have openings within a couple months here are cash pay practices.
 
As the title says, residency graduation is fast approaching and I'm planning to start private practice. Aiming to fill 20 hours a week. I'm going to be in a large metropolitan area in California.

I imagine geography matters, but if I were to get on a couple of the best paying panels, any idea how long I might expect to wait to fill those 20 hours? Assume no major bottle neck in terms of my ability to see new intakes..I could realistically do 5-6 per day.
Better have someone ready to answer the phones because I would imagine that you are going to be slammed with work. The only barrier will likely be how long it takes people to sift through the internet to find out you have appointments available. My family in California can’t even get into see a therapist not to mention a psychiatrist who takes insurance and states cash pay is the only way to get in to see anyone.
 
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About first 3 months I was only working 20 hours. After 3 months I was at about 40+ hours but there were still more than wanted open spots and still new patients pouring in.

If this seems bad to you most people in other fields tell me it's a year later and they still are having too much free time.
 
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Is that area saturated? If you take insurance, your practice in my metro area would be filled out for months in less than a few weeks. The only people who have openings within a couple months here are cash pay practices.
My sense is no, It is not saturated. I've called a few different psychiatrists and the majority have waiting lists.
 
About first 3 months I was only working 20 hours. After 3 months I was at about 40+ hours but there were still more than wanted open spots and still new patients pouring in.

If this seems bad to you most people in other fields tell me it's a year later and they still are having too much free time.
Sorry, maybe I haven't had enough coffee. Are you saying that you were at 40 hours clinically a week in about a year?
 
If saturated, like where I used to be, didn't happen even after 3 years. But I also dropped one insurance company that was about 20% of the local market.

My new area is looking optimistic and closest nearby Psychiatrist has a 6 month wait list. Saturation spots exist in the country.
 
Sorry, maybe I haven't had enough coffee. Are you saying that you were at 40 hours clinically a week in about a year?

He is saying that for the first three months he had only 20 hours available for patients. after 3 months he had openings for 40+ clinical hours a week and was generally full, but that he had enough availability that people could be seen while offering 40+ hours.

That's a good slowing down point since you want people to still be able to schedule follow-ups on the clinically appropriate time point instead of a one-size-fits-all interval. Still seeing some intakes but also not favoring new patients over current patients. There wasn't a major wait list, essentially.

He is also saying that in other specialties in the same region it would take more than a year and they'd still not have the same hours filled.
 
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I'm in a large California metro and take most insurances. I get on average 2-3 new patients per insurance per week. You can do the math from there to figure out how long it would take you to fill.
 
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It also depends on how many new intakes you actually want to do a week, we've touched on this before but doing a month of 6 intakes a day will make you want to schedule your own psychiatry intake....so eventually people start slowing down. Now I get annoyed if I have more than 1 intake a day.
 
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Probably within 6 months realistically at the fastest. There's a lot more to starting a PP than just doing intakes that takes some time to learn. I do know some solo psychiatrists in large metros area in CA who take 1-2 insurances and not full yet after a year or two but others who are solo and are full within a few months. "Full" means different things to different people. You only need 1 to fill.

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Let's do the math. 20 hours a week of clinical work equates to forty 30 minute visits a week eventually when you're full. If you are seeing patients once a month, that means you need about a little more than 160 patients to fill (a little over 4 weeks a month).

If you're doing 5 intakes a day, that means you need 160/5 = 32 days to fill. But wait, isn't 5 intakes (if you do hourly intakes) 5 hours a day x 5 days a week = 25 hours per week? If you want to stick to 20 hours a week, then you'll do 4 intakes a day at the most which means 160/4 = 40 days to fill.

If you are working 5 days a week (uncommon as private practice psychiatrists work 3-4 days a week on average), that means you need at least 8 weeks (2 months) to fill at the fastest after subtracting days off/weekends and if you are working 4 days a week, then 10 weeks (2.5 months). This is not accounting for hours you need to do follow-up appointments nor does it account for any time off or holidays that you want.

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More realistically, you'd be doing 2-3 intakes per day and having 2-3 hours for follow-ups per day. At this rate, you'd need to do 160/2 = 80 days to fill. At 4 days a week of work, that means it would be 20 weeks = 5 months to fill at this pace if you don't take any days off (such as for holidays).

In both of these models, here some of the assumptions:
  • Every intake you will accept as a patient. This is not common in private practice as you will do one time consultations or after the intake, you or they won't think it's a good fit. Whittling out those who aren't a good fit for you and vice versa is a way to build up a great PP panel that fits your practice style.
  • You will be optimized from the get go and have reasonable processes in place to do at least 2 intakes a day.
  • You're not doing any one hour follow-up visits (such as in psychotherapy). If you are, you would need to cut down the number of patients you need to fill by 4 each month per weekly psychotherapy patient. Unfortunately with insurance, you may have to prove that it is "medically necessary" for them to see you and not an alternative, like a cheaper therapist (if other people have thoughts on this, would love for you to chime in). Convenience for the patient or for you to have therapy+meds in one place doesn't count as "medical necessity" by insurance.
  • You will work outside those 20 patient-facing hours a week doing admin work, such as doing notes and learning how to documenting in compliance with insurance, getting collateral, doing phone screens, working on your website, filling out forms, doing refills, networking with therapists and other psychiatrists, sorting out claims and working with ApexEDI, figuring out how to do your own bookkeeping and taxes, trying to get an office and furniture set up if you want to do in person appointments, etc.
  • You won't get burnt out from the speed of the huge learning curve.

Also, one of the biggest reasons why people don't fill is because of obscurity: takes a long time to get on the insurance directory of listed providers, don't have a referral network yet, SEO isn't optimized, and other reasons why people can't find you. You're open for business and can help people, but they don't even know you exist!
 
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