Income expectations?

[Attending1985]

I’m an employed psychiatrist. I work for a hospital system that thus far has been really good to me. About a year ago I asked to expand my psychotherapy patients from a handful to half of my practice. They agreed. Since this time, a few nps have left and they are starting to make statements about improving access that give me the impression they might ask me to forgo therapy to see more patients. I can’t go back to that model full time. I love practicing psychotherapy and feel passionate about it. My job satisfaction is so much better now. If they no longer want to support me practicing this way I’m prepared to leave. I’m wondering what kind of financial hit I will take practicing on my own seeing patients for one hour for medications and psychotherapy if I accept insurance? I don’t make a ton now my full time salary is 240k.

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[nexus73]

I would try not to jump to conclusions that they will make a change and you'll be forced to leave. Is there anyone you can talk to, like a clinical manager who you have a good relationship with to share your concerns and see if they know what the organization's intentions are to improve access? Or is there a physician who oversees your department that you trust? I think worst case scenario for them is you leave entirely. You could always cut down to 0.8 or 0.6 FTE and see people for meds at the hospital clinic, and start a part time private therapy practice one to two days a week on your own.

 

[Sushirolls]

If I liked doing therapy, I'd be full, and I probably wouldn't be doing insurance.
Doing therapy and/or med management, you can really set up a lean very low overhead practice and just do cash only.
If your goal is to match, 240k, it is within reason. Just a matter of long to get there.

The insurance aspect really is dependent upon what they pay in your local area.
Try to glean from your current job by clicking on the billing sections to see what the charges/reimbursement is for the patients relative to your current codes. Review your whole patient panel and what the insurance mix is what the relative % of each is.
Just know that you probably won't get the rates your current big box shop is getting if you do insurance.
Look to see if the patients you are doing therapy with are a higher % of one insurance over another.
Look at your current list of patients, what your panel size is reflect if that would be similar to what you would need if going solo.

In my area, taking insurance is likely to 'pay' more than if I do cash only. I'm apprehensive about when this shoe will drop.

I currently have ~120-130 or so. I'll likely be content at 200 patients for 20 clinical hours per week, and 300 to yield 30 hours per week. I suspect I'll sort of 'close' at around 200 or so.

I believe another poster on here does more cash and therapy heavy and full with ~35 hours with about 100 patients .

 

[Attending1985]

I would try not to jump to conclusions that they will make a change and you'll be forced to leave. Is there anyone you can talk to, like a clinical manager who you have a good relationship with to share your concerns and see if they know what the organization's intentions are to improve access? Or is there a physician who oversees your department that you trust? I think worst case scenario for them is you leave entirely. You could always cut down to 0.8 or 0.6 FTE and see people for meds at the hospital clinic, and start a part time private therapy practice one to two days a week on your own.

I haven’t outright asked yet. That’s a good suggestion. Unfortunately I can’t work outside the system per my contract so can’t have my own practice on the side.
I like practicing therapy so much I’d like to do it full time. They’d never go for that. That’s also a motivation for my question,

 

[nexus73]

I haven’t outright asked yet. That’s a good suggestion. Unfortunately I can’t work outside the system per my contract so can’t have my own practice on the side.
I like practicing therapy so much I’d like to do it full time. They’d never go for that. That’s also a motivation for my question,

Just remember everything is negotiable.

At the start of COVID we had a hospital hiring freeze, but we had a psychiatrist we wanted to interview and make an offer to. Admin clarified that yes, it's a hiring freeze sure, but not if we need somebody, so we were able to make the offer. So there are rules in place, but not everything is set in stone.

 

[deleted1100659]

In my experience when employers use the words "were going to expand access" it means make you see more patients, do more things/incur more liability in some shape or form, and get paid the exact same

 

[TexasPhysician]

Depending on geography and insurance reimbursement, it is possible to find $240k for all 1 hour visits 40 hrs/week with minimal benefits in an employed/contractor environment. It’s not easy but possible.

 

[nexus73]

In my experience when employers use the words "were going to expand access" it means make you see more patients, do more things/incur more liability in some shape or form, and get paid the exact same

Yes, I'd assume this is code for shorter appointments, or you we'll get you so full a 3 month follow up appointment is the soonest anyone can get back in, or you can only see patients 2-4 visits, then discharge back to PCP. Which all decrease quality of care and increase liability and stress level/burnout. Which I think is OK if you agree to it, but if it was me I would want increased compensation for improving access.

 

[PsyDr]

I would highly recommend seeking some guidance from the analysts, whether you believe in it or not. Those people have the inside scoop on the business of psychotherapy. I know a few that charge $200-300/hr, and require 2-3 sessions per week.

 

[dl2dp2]

lol: financial hit... i'd leave, take all my patients with me, and double my income doing all combined visits taking cash only.

 

[Attending1985]

Depending on geography and insurance reimbursement, it is possible to find $240k for all 1 hour visits 40 hrs/week with minimal benefits in an employed/contractor environment. It’s not easy but possible.

Do you know the % difference between billing 2 99214s and a 99214 + 90386

 

[TexasPhysician]

Do you know the % difference between billing 2 99214s and a 99214 + 90386

Not much, but you shouldn’t be billing that.

2 99214 + 90833 for each is almost double what you are doing now for two 30 min visits.

 

[ObsequiousAplomb]

I would highly recommend seeking some guidance from the analysts, whether you believe in it or not. Those people have the inside scoop on the business of psychotherapy. I know a few that charge $200-300/hr, and require 2-3 sessions per week.

Where I am $300/hour for analysis is the lowest end of the sliding scale. I know plenty of social workers with analytic training that charge $200-300/hour

 

[clausewitz2]

Do you know the % difference between billing 2 99214s and a 99214 + 90386

This differs dramatically based on insurance payors unfortunately. I can tell you from my experience that 99214 + 90838 is around 70% of what I could get from 99214+90833 x 2 . My cash rate is closer to 85% of what I could get from insurance for the two.

I agree with @TexasPhysician that if you are at all therapy inclined there is no reason you should be billing bare E&M codes on the regular for 30 minutes visits.

 

[calvnandhobbs68]

Do you know the % difference between billing 2 99214s and a 99214 + 90386

I mean you're probably going to somewhat lose money between billing any E+M plus therapy codes for 30 min visits vs hour long visits.

For instance, even 2x 99213 + 90833 gets me more than a 99214 + 90836. billing is stacked in favor of shorter visits overall generally.