Is the overhead for starting a psychiatry practice very cheap?

[olivarynucleus]

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I just want to know if psychiatrist can get away with seeing patients in a rented office, with a prescription pad, and their own malpractice insurance. I'm not sure how billing works, but could the psychiatrist do that themselves too?

 

[Shikima]

Like any other physician who rents office space?

 

[nitemagi]

Yes.

 

[TexasPhysician]

Sure

 

[smalltownpsych]

All you really need are a couple of chairs in a room. In fact, why rent when you could just find a nice quiet table at the local coffee shop? That's how this doc operated http://abcnews.go.com/Health/doctor...s-starbucks-defends-actions/story?id=20803865

 

[olivarynucleus]

Like any other physician who rents office space?

I mean, one room.

 

[whopper]

One doc who is a total quack did his practice on top of a bar where the staff were all female and required to wear skimpy outfits. I was one of the only other psychiatrists in the area and when I started working private practice in the area, that other guy immediately starting telling his patients to stay away from me cause I was the quack.

This guy by the way forced his patients to see him weekly no matter how good or bad they were doing, started patients on 4-6 meds on the first visit, injected one guy with a depot medication and the patient turned out to be allergic to it (the guy didn't know you're supposed to give it oral first to see if the patient could tolerate it) and his partner lost his medical license because he was giving all of his attractive female patients or young boy patients breast exams or rectal exams (yes he was a psychiatrist). That quack defended his partner in court saying it was standard of care for psychiatrists to do this.

So you you can pretty much do your office anywhere though I'm not saying it's good practice.

 

[Bartelby]

All you really need are a couple of chairs in a room. In fact, why rent when you could just find a nice quiet table at the local coffee shop? That's how this doc operated http://abcnews.go.com/Health/doctor...s-starbucks-defends-actions/story?id=20803865

I just wanted to take a momentary derailment to say... holy crap! 11 years in federal prison! Practicing out of a Starbucks is poor judgment, yes, but the only obviously illegal thing I read about in that article was Yee prescribing for a patient who was not present and handing it to another person (one instance with few details). They mentioned that he *gasp* prescribed painkillers for a patient with a history of heroin dependence as if it were something that self-evidently was malpractice and merited a long prison term, but is it really? When did using clinical judgment to say that the benefits of adequately treating pain in a patient with a history of opiate dependence outweigh the risks become criminal? I get that one of his patients died from an overdose, but a patient's overdosing alone does not constitute malpractice. It makes me wonder if any of us could face a felony for making (for instance) a clinical judgment that a patient appears to have ADHD and could benefit from stimulants...

We don't have all the details (and maybe if we did we would all agree his conduct was that egregious), but I wonder if people would clamor for 11 years in prison if the guy had prescribed for people out of a rented office instead of meeting up at a public venue (which, who knows, this doctor might have naively thought was a convenience to offer his patients)? I just really hope there was slam-dunk evidence that he was a drug dealer and not just a naive guy who was too trusting of drug seeking patients.

As for the OP's question: you can definitely start a solo practice and handle your own scheduling and billing. It is a relatively common model still.

 

[smalltownpsych]

I love to derail threads on Fridays. 😛 Besides the original question was too easy of an answer so had to inject something interesting into it.

One doc who is a total quack did his practice on top of a bar where the staff were all female and required to wear skimpy outfits. I was one of the only other psychiatrists in the area and when I started working private practice in the area, that other guy immediately starting telling his patients to stay away from me cause I was the quack.

This guy by the way forced his patients to see him weekly no matter how good or bad they were doing, started patients on 4-6 meds on the first visit, injected one guy with a depot medication and the patient turned out to be allergic to it (the guy didn't know you're supposed to give it oral first to see if the patient could tolerate it) and his partner lost his medical license because he was giving all of his attractive female patients or young boy patients breast exams or rectal exams (yes he was a psychiatrist). That quack defended his partner in court saying it was standard of care for psychiatrists to do this.

So you you can pretty much do your office anywhere though I'm not saying it's good practice.

Are you saying that my idea to run a group mental health practice using skimpily clad girls as office staff is a bad idea? You and my wife and the stodgy old folks at the licensing board must be in cahoots. 😡

 

[heyjack70]

All you really need are a couple of chairs in a room. In fact, why rent when you could just find a nice quiet table at the local coffee shop? That's how this doc operated http://abcnews.go.com/Health/doctor...s-starbucks-defends-actions/story?id=20803865

The Starbucks doctor is funny. He was basically running an opioid pill mill out of Starbucks and got caught by the DEA. He was charging $300-600 per visit and his rationale was the high price would keep doctor shoppers/addicts away. That makes no sense.

From the standpoint of two chairs in a room, some psychiatrists would prefer this because it minimizes transference issues...outside of maybe the patient assuming their psychiatrist is extremely cheap.

 

[smalltownpsych]

The Starbucks doctor is funny. He was basically running an opioid pill mill out of Starbucks and got caught by the DEA. He was charging $300-600 per visit and his rationale was the high price would keep doctor shoppers/addicts away. That makes no sense.

From the standpoint of two chairs in a room, some psychiatrists would prefer this because it minimizes transference issues...outside of maybe the patient assuming their psychiatrist is extremely cheap.

I have two beautiful chairs, matching sofa, and a beautiful Amish made wood desk. I got in trouble with admin when I ordered it all. They told me to order new office furniture so I did. They forgot to tell me to go through purchasing so they could try to cheap it out so now all my patients think I am a big spender cause it all looks pretty swank for this small rural town. 😀

 

[Ceke2002]

Are you saying that my idea to run a group mental health practice using skimpily clad girls as office staff is a bad idea? You and my wife and the stodgy old folks at the licensing board must be in cahoots. 😡

Ugh, I know! I'm still trying to convince my Psychiatrist that a therapeutic field trip to a strip joint is a perfectly good idea, and he just won't bite. Damn stick in the mud *grumble grumble*.

😏

 

[OldPsychDoc]

Ugh, I know! I'm still trying to convince my Psychiatrist that a therapeutic field trip to a strip joint is a perfectly good idea, and he just won't bite. Damn stick in the mud *grumble grumble*.

😏

Paging Dr. Vistaril. Paging Dr. Vistaril. Your specific expertise is being requested.

 

[MacDonaldTriad]

I'm telling you, you have to say it three times for him to appear. I saw it in a pin head movie.

(Sigh), I kind of miss our resident ecdysiast aficionado.

 

[Shikima]

 

[nitemagi]

When I used to do "street medicine" work with the homeless, you treat people anywhere you can. Street corners, coffee shops (sometimes it's not safe to meet at their home, and they were unable to get to an office). I don't think it's malpractice, as long as you have informed consent from them on the downsides (particularly confidentiality). This was also a government funded program to target those who were slipping through the cracks of the regular system.

 

[Frazier]

On the real, in the past I had some ideas floating around my head about putting together a really nice RV with office-like interior. Then taking that dynamic office to rural areas in my state on a part-time basis.

What is the reimbursement setup for something like that (ie government, insurances, etc)?

The instinct was "well, if no insurance will reimburse a mobile office, then it will have to be cash pay patients"...but the fact it would be rural areas likely eliminates that as very feasible.

 

[Ceke2002]

When I used to do "street medicine" work with the homeless, you treat people anywhere you can. Street corners, coffee shops (sometimes it's not safe to meet at their home, and they were unable to get to an office). I don't think it's malpractice, as long as you have informed consent from them on the downsides (particularly confidentiality). This was also a government funded program to target those who were slipping through the cracks of the regular system.

When I was on the streets we had a fantastic outreach program that would come out to us when we were working and not only hand out free condoms, clean needles and so on, but they also had nurses and counsellors who would do free basic health checks and offer psychological support, advice on rehab programs, and so on. It was never forced on us, but we knew they were there and we could go to them at any time. They always treated us with respect, they never judged any of us, and we appreciated what they did. I can't imagine anyone being in a similar situation who would even think of something like malpractice.

And I think it's awesome that you were involved in something similar. Major respect to you for that. 🙂

 

[jakeislove]

Ugh, I know! I'm still trying to convince my Psychiatrist that a therapeutic field trip to a strip joint is a perfectly good idea, and he just won't bite. Damn stick in the mud *grumble grumble*.

😏

Why not go alone?

 

[Ceke2002]

Why not go alone?

Hmm, not sure if serious or just completely missing a joke.

 

[jakeislove]

Hmm, not sure if serious or just completely missing a joke.

Make it rain!!

 

[Ceke2002]

Make it rain!!

So fielder's choice then

 

[Indodo]

All you need is a chair. If you don't get anything else, it's pretty cheap. Do it Clint Eastwood style. You can even pick your patients.