Is private pay adult NP practice feasible ?

[Westbound2019]

Just curious if anyone is doing this & would be willing to share their model/advice/marketing strategies.

I’m considering opening a small NP practice for adults. I know that accepting insurance would open accessibility to many and would fill the practice (based on convos with potential referring providers), but I’ve heard such horror stories about working with insurance unless you have the means to hire a billing specialist (i dont) and I’m wondering if there’s a way to do without - even if that means staying part time.

Ideas, advice, opinions welcome!

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[WisNeuro]

I do neuropsych in private practice. I take MC and insurance. I also do my own billing. I spend 15-30 minutes every two weeks on billing.

 

[Westbound2019]

I do neuropsych in private practice. I take MC and insurance. I also do my own billing. I spend 15-30 minutes every two weeks on billing.

Thanks for sharing ! Do you think this is a typical experience? (I.e., Are you super efficient/ have tricks or tips for accomplishing this, or are the horror stories I’ve heard about insurance just exaggerated?)

 

[WisNeuro]

Thanks for sharing ! Do you think this is a typical experience? (I.e., Are you super efficient/ have tricks or tips for accomplishing this, or are the horror stories I’ve heard about insurance just exaggerated?)

Getting credentialed in the first place is probably the worst part. But, if you don't want to do it, you can still pay a service to do that for you. As for billing, a couple of my colleagues who run small solo practices do all of theirs, one of which shares an office with me, and they haven't spoken about any big issues. We're all clinical/IME people, though, so we really only bill a little over a handful of clinical cases each two week period. Once you have the billing portals down, it's pretty quick. For example, I can easily enter in 2-4 Medicare patients billing info in about 10-15 minutes.

 

[PsyDr]

Adult cash is a no go for neuropsych. Neuropsychological disorders disproportionately affect the elderly and the indigent. Neither group will pay up, in bulk.

Billing medicare is a big nothing. You send a bill. They "correct" it, and send you money. Usually they forward the rest to the supplementary insurance.

 

[Westbound2019]

One other thing I’ve been told is that you can’t make a living in adult private practice taking insurance without doing forensic work. That can’t be true ….?

 

[WisNeuro]

One other thing I’ve been told is that you can’t make a living in adult private practice taking insurance without doing forensic work. That can’t be true ….?

Probably depends on the CoL where you plan to make that living. Working FT (40 hours a week) I could easily clear 150k just seeing clinical patients. However, I enjoy the IME work, and that just so happens to pay several times the amount I make hourly compared to clinical work. You can make a living either way, one just happens to pay substantially better.

 

[AcronymAllergy]

One other thing I’ve been told is that you can’t make a living in adult private practice taking insurance without doing forensic work. That can’t be true ….?

Like WisNeuro mentioned, it can vary depending on location and what insurers in your area pay, but I know of plenty of folks in the community who focus solely or predominantly on clinical work and seem to do fine. You'll probably want one or more psychometrists to make the most efficient use of your time, though.

You can look up the Medicare rates in your area online and do the math from there, assuming X number of evals at Y hours per week with Z% no-show rate, recognizing that private insurers may pay a bit more than Medicare, and deciding if you want to be the provider who sends an elderly patient to collections for failing to pay their co-pay after you've attempted to collect.

Now if a person wanted to make a practice solely out of Medicaid evals, that's another matter entirely...

 

[WisNeuro]

Like WisNeuro mentioned, it can vary depending on location and what insurers in your area pay, but I know of plenty of folks in the community who focus solely or predominantly on clinical work and seem to do fine. You'll probably want one or more psychometrists to make the most efficient use of your time, though.

You can look up the Medicare rates in your area online and do the math from there, assuming X number of evals at Y hours per week with Z% no-show rate, and recognizing that private insurers may pay a bit more than Medicare.

Now if a person wanted to make a practice solely out of Medicaid evals, that's another matter entirely...

I would make a slight distinction between solely Medicare and Medicare with a supplement. That supplemental insurance can add a nice chunk of change on top of your medicare billing.

 

[AcronymAllergy]

I would make a slight distinction between solely Medicare and Medicare with a supplement. That supplemental insurance can add a nice chunk of change on top of your medicare billing.

Very true and good point.

 

[WisNeuro]

Very true and good point.

Looked at the last couple months, depending on supplemental payor and what was billed, supplemental insurance paid an extra 91-154 per eval where it was present.

 

[Therapist4Chnge]

Probably depends on the CoL where you plan to make that living. Working FT (40 hours a week) I could easily clear 150k just seeing clinical patients. However, I enjoy the IME work, and that just so happens to pay several times the amount I make hourly compared to clinical work. You can make a living either way, one just happens to pay substantially better.

This has also been my experience.

I'm now 70% legal & 30% clinical, which is around the split I want to keep. This has freed me up to do some pro-bono work (clinical & consultation) and more volunteer work (not psych/clinical).

As for billing, I tried doing my own billing, and it just wasn't worth it. I admittedly only do workers comp and legal work, but WC was a nightmare to try and figure out on the fly. I never did my billing when I saw Medicare, so it was a steeper learning curve that proved not worth it to me.

Legal billing is easier, but more recently I decided to have my billing company handle that too. I pay them 8% (I've seen 6%-8%), which sounds like a lot, but it's a drop in the bucket compared to what I would have lost if I relied upon myself. It's important to go w a biller who knows Neuropsych billing bc you want/need to be credentialed on the medical side. Being credentialed through behavioral health anything will decrease your rates and add more hoops.

Commercial insurance tends to pay okay to poorly, and they definitely have some added hoops. A couple jobs ago (where I took limited commercial insurance), I made it worthwhile by billing 80%-100% of my cash rate, but it takes some more work up front. I negotiated with each insurer and often did 1 off contracts paid at my cash rate, so those were more reasonable. I knew the market, knew there was a shortage of Neuropsych, and I got them hooked on using me 1 contract at a time.

Insurers will rarely talk about one off contracts where you agree to see a specific patient for a negotiated fee/rate bc they want you to join their network and accept scraps for payment. You can always negotiate rates (except Medicare), so it pays to do your research and hold out for top dollar.

ps. All of this is written as someone 10yrs post fellowship, exp w multiple private practice settings, and with a biz background. Don't expect to run a largely cash practice coming out of fellowship, but it can be done of you can build a reputation and find a good niche.

 

[PsySeeker]

One other thing I’ve been told is that you can’t make a living in adult private practice taking insurance without doing forensic work. That can’t be true ….

I was told the same. I think it’s perpetuated by folks that don’t know how to run a business, and tell themselves there is no money in it so they don’t have to think too hard about trying it (generalizing, blowing a bit of smoke, it’s Friday and I’m beat, who really knows why people say it).

Reality is it depends on the payer (which is going to vary by region, and there is at least one big player that is a reimbursement horror show, hopefully it’s a bit player or absent in your neighborhood) and how you define “a living”. Scheduling 40 folks a week and taking two weeks off with a 10% no show rate taking Medicare or the decent national insurers you’d gross over 250k. That’s a fairly lazy load tho and a relatively high average no show rate. If you don’t mind working and run a tight ship you can gross in the mid to high 300s solo if you work 9 hours a day and 5 hours or so Saturday mornings doing absolutely nothing but adult psychotherapy in-network.

 

[AcronymAllergy]

To add to all of the above, another way to increase the amount you take home is by having an officemate. Even if all you do is share expenses (i.e., they don't pay you a portion of their billing), said expenses probably won't increase very much, especially the set ones like rent, and now they've effectively been halved.

 

[WisNeuro]

To add to all of the above, another way to increase the amount you take home is by having an officemate. Even if all you do is share expenses (i.e., they don't pay you a portion of their billing), said expenses probably won't increase very much, especially the set ones like rent, and now they've effectively been halved.

I do this. We're separate business entitites (but both neuropsych) but share an office suite with 4 rooms (waiting room, 2 offices, 1 storage/fax/copier room). So, splitting rent and utilities. Definitely keeps overhead down. Also, we can refer over to each other for cases if one of us doesn't have availability in the asked upon time frame.

 

[Westbound2019]

Any advice on resources to learn about the insurance process ? I’ve filled out a CAQH but still feel like I’d be flying by the seat of my pants trying to figure anything out. If I’m in a group practice , do all group members need to take insurance or do I need a separate EIN to do this ?

 

[PsySeeker]

Any advice on resources to learn about the insurance process ? I’ve filled out a CAQH but still feel like I’d be flying by the seat of my pants trying to figure anything out. If I’m in a group practice , do all group members need to take insurance or do I need a separate EIN to do this ?

I don’t really follow the question. What are you trying to do? Credential yourself or credential a group? A separate EIN to do what? An EIN is just a tax payer ID number for an entity, like a corp, LLC, LP, etc. Depending on what you are trying to achieve and where you are you will form some sort of entity and then register an EIN for it and have the payers pay it. Getting a group practice credentialed can be a bit tricker. Often it involves a similar process with more steps, but then everyone who wants to take the insurance in the group has to be credentialed under the group as well, generally, anyway.

I didn’t find it that hard to feel my way through it, but I set up a professional LLC and am practicing solo and have it flowing through my personal taxes so it was probably as simple as this stuff gets. If you are really lost at sea, or just know what you don’t know, the best advice is to consult a local lawyer.

 

[Westbound2019]

I don’t really follow the question. What are you trying to do? Credential yourself or credential a group? A separate EIN to do what? An EIN is just a tax payer ID number for an entity, like a corp, LLC, LP, etc. Depending on what you are trying to achieve and where you are you will form some sort of entity and then register an EIN for it and have the payers pay it. Getting a group practice credentialed can be a bit tricker. Often it involves a similar process with more steps, but then everyone who wants to take the insurance in the group has to be credentialed under the group as well, generally, anyway.

I didn’t find it that hard to feel my way through it, but I set up a professional LLC and am practicing solo and have it flowing through my personal taxes so it was probably as simple as this stuff gets. If you are really lost at sea, or just know what you don’t know, the best advice is to consult a local lawyer.

Thank you - you’re right I am over complicating this!! I have a few particular questions that would be best suited for a lawyer, and the rest is actually very straight forward. Appreciate your input !

 

[WisNeuro]

I don’t really follow the question. What are you trying to do? Credential yourself or credential a group? A separate EIN to do what? An EIN is just a tax payer ID number for an entity, like a corp, LLC, LP, etc. Depending on what you are trying to achieve and where you are you will form some sort of entity and then register an EIN for it and have the payers pay it. Getting a group practice credentialed can be a bit tricker. Often it involves a similar process with more steps, but then everyone who wants to take the insurance in the group has to be credentialed under the group as well, generally, anyway.

I didn’t find it that hard to feel my way through it, but I set up a professional LLC and am practicing solo and have it flowing through my personal taxes so it was probably as simple as this stuff gets. If you are really lost at sea, or just know what you don’t know, the best advice is to consult a local lawyer.

Second this, you need a lawyer with experience in the area, as well as a good CPA who has experience in this area. They can run you through the details and when what may make sense. For example, are you a disregarded entity? An S-corp that you are an employee of, etc?

 

[thebalmofhurtminds]

I was told the same. I think it’s perpetuated by folks that don’t know how to run a business, and tell themselves there is no money in it so they don’t have to think too hard about trying it (generalizing, blowing a bit of smoke, it’s Friday and I’m beat, who really knows why people say it).

Reality is it depends on the payer (which is going to vary by region, and there is at least one big player that is a reimbursement horror show, hopefully it’s a bit player or absent in your neighborhood) and how you define “a living”. Scheduling 40 folks a week and taking two weeks off with a 10% no show rate taking Medicare or the decent national insurers you’d gross over 250k. That’s a fairly lazy load tho and a relatively high average no show rate. If you don’t mind working and run a tight ship you can gross in the mid to high 300s solo if you work 9 hours a day and 5 hours or so Saturday mornings doing absolutely nothing but adult psychotherapy in-network.

I would not classify 40 folks a week as a "fairly lazy load" to be honest.

 

[Sanman]

I don’t really follow the question. What are you trying to do? Credential yourself or credential a group? A separate EIN to do what? An EIN is just a tax payer ID number for an entity, like a corp, LLC, LP, etc. Depending on what you are trying to achieve and where you are you will form some sort of entity and then register an EIN for it and have the payers pay it. Getting a group practice credentialed can be a bit tricker. Often it involves a similar process with more steps, but then everyone who wants to take the insurance in the group has to be credentialed under the group as well, generally, anyway.

I didn’t find it that hard to feel my way through it, but I set up a professional LLC and am practicing solo and have it flowing through my personal taxes so it was probably as simple as this stuff gets. If you are really lost at sea, or just know what you don’t know, the best advice is to consult a local lawyer.

I'm curious as to why you would choose a solo practice and not opt for mid levels when going for volume?

 

[Therapist4Chnge]

I would not classify 40 folks a week as a "fairly lazy load" to be honest.

Agreed. Assuming 5 work days per week, 6-8 therapy pts per day can be a lot, especially if working w. real psych issues and not just the worried well.

 

[WisNeuro]

Agreed. Assuming 5 work days per week, 6-8 therapy pts per day can be a lot, especially if working w. real psych issues and not just the worried well.

When it came to therapy, I always found the worried well to be more tiring. I'd much rather be working on actual target issues than more supportive work.

 

[Sanman]

When it came to therapy, I always found the worried well to be more tiring. I'd much rather be working on actual target issues than more supportive work.

I find the worried well to be rather boring, but it pays appropriately. Mild levels of mental health concerns are the best for me. Moderate to severe cases generally tax the resources of outpatient mental health and are not worth treating due to the increased need for case management time and appropriate documentation, ime.

 

[WisNeuro]

I find the worried well to be rather boring, but it pays appropriately. Mild levels of mental health concerns are the best for me. Moderate to severe cases generally tax the resources of outpatient mental health and are not worth treating due to the increased need for case management time and appropriate documentation, ime.

Been a long while since I've done DBT or ED treatment, but yeah, those were pretty resource intensive. On the therapy side, I pretty much only see some select panic disorder and PTSD in recent work.

 

[PsySeeker]

I'm curious as to why you would choose a solo practice and not opt for mid levels when going for volume?

I guess a couple reasons. I grew my PP 100% virtually. I have office space I’ve never used 😂. I am utterly slammed/waitlisted with demand. I think about trying to add on clinicians but I have literally no time. I’d need to cut my caseload down, but I like the work, find it hard to give up clinical time. I also kind of like not having to deal with anyone but my patients during my typical work day. I’m also hitting high threes gross solo, which is better than I expected and kind of gives me pause about the need take on that aspect of it. Finally, I’m becoming known for what I do. I’m concerned masters folks won’t represent my company the way I do.


But then I know that I could get it to a mill plus gross in a year and I ponder.

 

[PsySeeker]

I would not classify 40 folks a week as a "fairly lazy load" to be honest.

It was 40 less 10% so 36 a week is kinda lazy. I schedule 46 during weekdays, 4 to 5 early Saturday, and 2 late Sunday evenings. Been doing that for two years. Usually 53 or so l. Feels fine.

 

[thebalmofhurtminds]

It was 40 less 10% so 36 a week is kinda lazy. I schedule 46 during weekdays, 4 to 5 early Saturday, and 2 late Sunday evenings. Been doing that for two years. Usually 53 or so l. Feels fine.

That's fantastic for you. But again, let's be honest. 36-40 patients a week is not "lazy." And I think most people would agree that working with moderate-severe cases at that high level is a recipe for burnout. I'm glad it works for you. But let's not pretend that's the norm. That schedule would make work-life balance nearly impossible.

 

[erg923]

It was 40 less 10% so 36 a week is kinda lazy. I schedule 46 during weekdays, 4 to 5 early Saturday, and 2 late Sunday evenings. Been doing that for two years. Usually 53 or so l. Feels fine.

Most people value their family and children's time more than that.

 

[PsyDr]

That's fantastic for you. But again, let's be honest. 36-40 patients a week is not "lazy." And I think most people would agree that working with moderate-severe cases at that high level is a recipe for burnout. I'm glad it works for you. But let's not pretend that's the norm. That schedule would make work-life balance nearly impossible.

Psychiatrists disagree

 

[thebalmofhurtminds]

Psychiatrists disagree

Oh, well in that case, I would certainly amend my statement. Or wait, are you referring to the field with one of the highest rates of burnout and suicide?

APA-BOT-Workgroup-Psychiatrist-Wellbeing-and-Burnout.pdf

 

[PsyDr]

Oh, well in that case, I would certainly amend my statement. Or wait, are you referring to the field with one of the highest rates of burnout and suicide?

APA-BOT-Workgroup-Psychiatrist-Wellbeing-and-Burnout.pdf

Yeah, I'm referring to the field with equitable, if not lower, rates of burnout, suicidal ideation, and completed suicides (e.g., Kleespies, P. M., et al; 2011).

How would you amend your statement?

 

[thebalmofhurtminds]

Yeah, I'm referring to the field with equitable, if not lower, rates of burnout, suicidal ideation, and completed suicides (e.g., Kleespies, P. M., et al; 2011).

How would you amend your statement?

Psychiatrists see too many patients as well, as we can see from the burnout/SI/etc. stats. But we're comparing apples to oranges, since many can and do utilize 15-30 minute appointments for medication management. My statement was specifically referring to 40 full therapy cases.

 

[Sanman]

Yeah, I'm referring to the field with equitable, if not lower, rates of burnout, suicidal ideation, and completed suicides (e.g., Kleespies, P. M., et al; 2011).

How would you amend your statement?

I vote that this is a dumb argument. It can be done, but burnout is real. As someone who used to see up 60 patients/wk and now sees 8-10, I can tell you this my attention to treatment planning , session prep, and my tolerance for non-clinical issues has gone up. Unfortunately, that is the way money is made. I work with too many psychiatrists that are content to throw a pill at someone without proper communication, history, etc to think that there does not need to be a better balance to both cultures.

 

[clausewitz2]

As perspective, I currently see 14-16 people per day in private practice as a psychiatrist, none for less than 30 minutes, and it is frankly too much. My happy place would be 11-12. It is true that psychiatric follow-ups are a totally different animal than full therapy cases, and this is partly due to appropriate evaluation and management involving more structured routine conversations that are the same across appointments. It is also the case that as I control my own schedule I end up bringing people back more frequently (e.g. every two weeks or weekly) than I think some of my colleagues do if there is anything serious going on, which lessens the cognitive burden. I have maybe one new patient a week at this point and I refuse to see more than one per day (and also really don't have to).

Additionally, a small percentage of my patients are basically fine and really do just need me to send a prescription somewhere but who don't want to return to their PCP for whatever reason; I don't have so many of these folks because i actually insist on doing a proper dedicated semi-structured clinical interview to assess for ADHD and so the folks who really just want their Addys go elsewhere. I could do a day of 14 of those folks and still have plenty of gas left in the tank.

Still, I have an active panel of ~180 and despite what CMHC admins may think, we can all agree nobody should have a therapy caseload like this. Meanwhile I know people in family medicine or dermatology who see 40 people a day. There are psychiatrists seeing 4 patients an hour doing something similar, but either that is an inflexible employer, them being uncomfortable with meaningful therapeutic relationships, or perhaps being ignorant of current payment structure. At present I can do well by doing good and difference income between me and Mr. Med Check is negligible.

 

[Sanman]

As perspective, I currently see 14-16 people per day in private practice as a psychiatrist, none for less than 30 minutes, and it is frankly too much. My happy place would be 11-12. It is true that psychiatric follow-ups are a totally different animal than full therapy cases, and this is partly due to appropriate evaluation and management involving more structured routine conversations that are the same across appointments. It is also the case that as I control my own schedule I end up bringing people back more frequently (e.g. every two weeks or weekly) than I think some of my colleagues do if there is anything serious going on, which lessens the cognitive burden. I have maybe one new patient a week at this point and I refuse to see more than one per day (and also really don't have to).

Additionally, a small percentage of my patients are basically fine and really do just need me to send a prescription somewhere but who don't want to return to their PCP for whatever reason; I don't have so many of these folks because i actually insist on doing a proper dedicated semi-structured clinical interview to assess for ADHD and so the folks who really just want their Addys go elsewhere. I could do a day of 14 of those folks and still have plenty of gas left in the tank.

Still, I have an active panel of ~180 and despite what CMHC admins may think, we can all agree nobody should have a therapy caseload like this. Meanwhile I know people in family medicine or dermatology who see 40 people a day. There are psychiatrists seeing 4 patients an hour doing something similar, but either that is an inflexible employer, them being uncomfortable with meaningful therapeutic relationships, or perhaps being ignorant of current payment structure. At present I can do well by doing good and difference income between me and Mr. Med Check is negligible.

You guys have it better on the billing front, the fact that all psychotherapy codes are time based with minimal reimbursement for complexity and cognitive work means that we are actually rewarded for doing bad therapy. Why provide proper care and treatment planning when unprepped supportive therapy is allowed to be reimbursed and it is all the same rate?

 

[erg923]

Yeah, I'm referring to the field with equitable, if not lower, rates of burnout, suicidal ideation, and completed suicides (e.g., Kleespies, P. M., et al; 2011).

How would you amend your statement?

@PsyDr I love you, and I care about you (like Stewie Griffin cares about Brian Griffin), but you are being silly here...aight?

Psychiatry (or the common practice of) is NOT what the poster was talking about. And I don't care what they think about my work hours. And we need to confess that, despite what some posters may assert...the overwhelming majority of us "normies" have spouses and children to think about. People like us counsel the business and medical workaholic folks like that in order to specifically remediate effects of burnout based on that mentality/culture, right?

SDN...I think we need to check-in on this guy more?

Hashbrown# Can we mary off the PsyDr?

 

[PsyDr]

I vote that this is a dumb argument. It can be done, but burnout is real. As someone who used to see up 60 patients/wk and now sees 8-10, I can tell you this my attention to treatment planning , session prep, and my tolerance for non-clinical issues has gone up. Unfortunately, that is the way money is made. I work with too many psychiatrists that are content to throw a pill at someone without proper communication, history, etc to think that there does not need to be a better balance to both cultures.

While I understand that position, I have trouble reconciling it with multiple medical specialties watching death on the daily,

 

[PsyDr]

@PsyDr I love you, and I care about you (like Stewie Griffin cares about Brian Griffin), but you are being silly here...aight?

Psychiatry (or the common practice of) is NOT what the poster was talking about. And I don't care what they think about my work hours. And we need to confess that, despite what some posters may assert...the overwhelming majority of us "normies" have spouses and children to think about. People like us counsel the business and medical workaholic folks like that in order to specifically remediate effects of burnout based on that mentality/culture, right?

SDN...I think we need to check-in on this guy more?

Hashbrown# Can we mary off the PsyDr?

Says the guy who insisted that covid19 wasn’t a real thing.

 

[erg923]

Says the guy who insisted that covid19 wasn’t a real thing.

What ya know but what they tell ya, son?

 

[Sanman]

 

[AcronymAllergy]

Whether or not we have the same practice model as psychiatry, broadly speaking, I think it's dangerous not to take cues from their and other physicians' workloads and patient flow. After all, they represent the vast major of players at the reimbursement table (at least until nursing takes over the world), and they're to whom we're going to be compared; just think how well your CMOs and hospital administrators actually understand what you do. Trying to insist we're different, even if we are, may not be a viable option until we actually have more sway in the decision making (and better profession-wide involvement in advocacy). I'm pretty sure that's what contributed to us getting cut out of E&M codes to begin with, way back when.

I'm a big proponent of reasonable workload expectations relative to compensation. Hospital systems shouldn't be expecting a psychologist to see 40 patients/week if they're only paying them 80-90k/year, and psychologists shouldn't accept that compensation for that workload. But we do also benefit, as a profession, from the workhorses amongst us.

 

[WisNeuro]

I'm a big proponent of reasonable workload expectations relative to compensation. Hospital systems shouldn't be expecting a psychologist to see 40 patients/week if they're only paying them 80-90k/year, and psychologists shouldn't accept that compensation for that workload. But we do also benefit, as a profession, from the workhorses amongst us.

I think this is where the PP shines. I can turn up or down the faucet as much as I want. Have a big purchase coming up (e.g., car) slot in an extra eval here and there, accept a few more IMEs for the quarter and we're golden. Busy travel month coming up, lighten the load. It's nice to actually see the increased work lead to substantially more income, as opposed to busy weeks in salaried jobs just leading to the same paycheck.

 

[Sanman]

Whether or not we have the same practice model as psychiatry, broadly speaking, I think it's dangerous not to take cues from their and other physicians' workloads and patient flow. After all, they represent the vast major of players at the reimbursement table (at least until nursing takes over the world), and they're to whom we're going to be compared; just think how well your CMOs and hospital administrators actually understand what you do. Trying to insist we're different, even if we are, may not be a viable option until we actually have more sway in the decision making (and better profession-wide involvement in advocacy). I'm pretty sure that's what contributed to us getting cut out of E&M codes to begin with, way back when.

I'm a big proponent of reasonable workload expectations relative to compensation. Hospital systems shouldn't be expecting a psychologist to see 40 patients/week if they're only paying them 80-90k/year, and psychologists shouldn't accept that compensation for that workload. But we do also benefit, as a profession, from the workhorses amongst us.

It really depends on what practice model you are following as well. Seeing 9 pts/day was not that taxing when accepting cash only. Pay me, have session, move on. Managing multiple insurers and mandates was a lot more frustrating and required much more in terms of documentation, authorization issues, and utilization reviews.

 

[WisNeuro]

It really depends on what you are doing as well. Seeing 9 pts/day was not that taxing when accepting cash only. Pay me, have session, move on. Managing multiple insurers and mandates was a lot more frustrating and required much more in terms of documentation, authorization issues, and utilization reviews.

Yeah, pay definitely changes the equation. My bar for dealing with a PITA patient for clinical work is much lower than my bar for dealing with problematic issues in IMEs where the hourly rate is about 5-6X higher.

 

[Therapist4Chnge]

Yeah, pay definitely changes the equation. My bar for dealing with a PITA patient for clinical work is much lower than my bar for dealing with problematic issues in IMEs where the hourly rate is about 5-6X higher.

If an IME no shows....$1000. If a clinical patient no shows....$0-$50 no show fee. I'll deal with the headache that comes w. doing legal work bc my time is paid for, regardless if the person shows up.

 

[WisNeuro]

If an IME no shows....$1000. If a clinical patient no shows....$0-$50 no show fee. I'll deal with the headache that comes w. doing legal work bc my time is paid for, regardless if the person shows up.

You should up that no-show fee.

 

[PsySeeker]

Most people value their family and children's time more than that.

I know you gotta defend that ego/life choices Erg, I’ve watched you do it on here for 9 years now. Cheap shots, snark, self-aggrandizing….

FWIW I think it’s likely that you are a good father. Thing is, I don’t have to be a bad one for that to be the case, and my being far more financially successful than you’ve been likewise doesn’t mean I value my children any less (or more) than you do. So let’s drop the defensive posturing for once. I can teach you, let me know if you want a consult.

For the record, I’m with my kids by 5:30 pm weeknights and before lunch Saturday, and all day Sunday. I’ll be able to support them both through college and grad school and I’ll be able to provide them both with significant financial freedoms/advantages beyond that, which given the current state of this nation/world and our continued general and steady decent into the abyss, I feel they may truly appreciate. I can do this while still spending more time with them then the average corporate drone with a commute, most all retail workers, many construction workers, and most MDs, lawyers and dentists. I can do it while providing much needed services to many survivors of sexual assault/trauma, which I love to provide, when they need it most, an era of trauma and pain when there are clearly not nearly enough psychologist to meet the very real and very raw needs of badly hurting folks.

My heads held high. I’m doing what I can. I’m happy to help others build something similar too, all they have to do is ask.

 

[PsySeeker]

That's fantastic for you. But again, let's be honest. 36-40 patients a week is not "lazy." And I think most people would agree that working with moderate-severe cases at that high level is a recipe for burnout. I'm glad it works for you. But let's not pretend that's the norm. That schedule would make work-life balance nearly impossible.

I’ll agree scheduling 40 isn’t lazy. I disagree it’s a recipe for burnout. 36 to 40 shows a week would actually result in a moderate to light work schedule compared to most professions. Indeed, applying that to the hours I work my work week would be 5 days/no weekends, and I’d be done with clients by 3:30, even with taking a half hour lunch, and I’d be climbing out of my basement lair and into my personal life by about 4pm.

FWIW, following this schedule one would expect to gross very close to $300,000 with two to three weeks vacation factored in.

 

[PsyDr]

What ya know but what they tell ya, son?

Since you’re so sure, I’ll assume you’ve leveraged the house and retirement to create a margin account to short the rest of us.

Or you ain’t so sure.

Didn’t see you at those meetings