Job Offer Commentary

[ObsequiousAplomb]

What less desirable outcomes in pp? I can't glean it from the thread

He has a very large thread on this forum, recommend you go there. In general, his practice grew slowly, he had signed an expensive lease planning for expansion that was slow to happen, and now his biggest payers are slashing rates. He loved the autonomy but is feeling pressured to go back to employment to fund his hobbies and avoid the rat race.

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[Sushirolls]

He has a very large thread on this forum, recommend you go there. In general, his practice grew slowly, he had signed an expensive lease planning for expansion that was slow to happen, and now his biggest payers are slashing rates. He loved the autonomy but is feeling pressured to go back to employment to fund his hobbies and avoid the rat race.

Applause. Good summary. I'd edit the fund the hobbies, to actually transition form medicine to farming to be a true income source. If I'm lucky I'll die on a tractor or in the hay barn. Used to think I'd be the old psychiatrist getting license yanked away, but things change in life. "green acres is the place to be..."

 

[nexus73]

If you get 300K for 32 hours, you could do 16 patient hours a week, two 8 hour days, or one 12 hour day one 4 hour day, or 10 and 6 and get 150K presumably, and if you could get benefits that would be great. Then you have 3 to 3.5 days to do PP or whatever else you want.

 

[PikminOC]

Applause. Good summary. I'd edit the fund the hobbies, to actually transition form medicine to farming to be a true income source. If I'm lucky I'll die on a tractor or in the hay barn. Used to think I'd be the old psychiatrist getting license yanked away, but things change in life. "green acres is the place to be..."

What hobbies do you like? Why did you want a lease expansion?

 

[hamstergang]

cf*x

I was skimming this post and had to stop for a while to figure out what curse word this was. I did eventually realize "conversion factor times x."

 

[ObsequiousAplomb]

What hobbies do you like? Why did you want a lease expansion?

I incorrectly said hobbies. He wants to be a rancher. My dad is a retired psychiatrist who has a ranch and he always calls it a hobby. I guess my consideration of Sushi as a surrogate father shined through in my mistake.

Sushi leased an office that could be a setup for neuromodulation under the dream (that many of us share) of offering ECT and TMS to an area without any. Another psychiatrist took over TMS and the local hospitals were too slow to set up his privileges for ECT. So the dream died. Seriously though, you should read the thread. There's a lot I'm glossing over.

 

[Sushirolls]

I incorrectly said hobbies. He wants to be a rancher. My dad is a retired psychiatrist who has a ranch and he always calls it a hobby. I guess my consideration of Sushi as a surrogate father shined through in my mistake.

Sushi leased an office that could be a setup for neuromodulation under the dream (that many of us share) of offering ECT and TMS to an area without any. Another psychiatrist took over TMS and the local hospitals were too slow to set up his privileges for ECT. So the dream died. Seriously though, you should read the thread. There's a lot I'm glossing over.

You nailed it.

 

[PikminOC]

You nailed it.

Thanks, I like the cliff notes.

 

[Geodont]

Rural, truly middle of no where.
Tractor traffic jams are real, and ringing of gun shots in the evening of people doing target practice are like the chimes of the church bells bellowing into the hills.
Likely only Psychiatrist with a Critical Care access hospital for a whole county/parish.
32 clinical hours denotes full time, 8 hours admin.
Salary guarantee of 300K
wRVU 'bonuses' trigger above 3800 per year, and at a rate of $56/wRVU
Outpatient only. no C/L, no call, no ED, no IP
Can set follow ups and intakes to desired time.
Can set limits on no populations; i.e. no CAP, etc
4 weeks vacation 5 weeks; and a 25K sign on
1 week CME with ~$3800
401k with some matching, (no 457 fund)
Admin and mid management consistently say, you tell us what you want to do, as not trying to burn out their doctors.
Other routine benefits of health insurance, disability, etc
Can also scale down the FTE status to 0.9 or 0.8 etc, to same ratios for wRVUs and clinical hours and salary guarantee.

What do y'all think of this job?
Is it worth leaving PP for?

Never believe admin job courtship bs lines that involve, “You tell us what what you want to do.”

That said, the bottom line on most jobs is location. If you could be happy in the landscape you describe without flying/driving out 1-2 weeks of the month or at least getting paid 425K/yr, jingle on.

 

[Sushirolls]

I'm staying in private practice, verdict is in.

 

[Bartelby]

What was the deciding factor for you?

 

[Sushirolls]

Never believe admin job courtship bs lines that involve, “You tell us what what you want to do.”

That comment.
And the other threads glorifying private practice SEP-IRA and solo 401k as retirement vehicles over W2.

It was just a reminder that PP really is king, and the only real positive I could see is not dealing with payment/collections. But everything else for running a private practice I have dialed in, and a good assistant.

I just need to build up the practice. I'm optimistic this location will have greater growth than current. Plus, I won't have to grow that much as I already have a lot of loyal patients. More, so, just need to top off.

The idea of doing 4 consults or more in a day to build up a new practice... I just don't have the stamina to do that again. I'm making my stand with this practice. The BOSS says I have 2 years to make it hum, or she'll make me shut it down and go do an employed job. Even the thought of each consult I'd do is worth X dollars, but then seeing it as wRVUs, and knowing the flick of a pen, the admin could change the wRVU game over night.

I've tasted freedom. I can't ... I can't go back.

Even something as simple as vacation days. I don't want to have to ask. I want to go click click on my calendar and be done with it. No asking, just doing.

I have taken steps to consolidate my schedule so it will truly be 3 days clinical, rather than a more drawn out schedule in the whole week. It'll be nice to truly have a 3 day weekend. Can always expand into that if wanted in the future, but parsing out work versus non-work days is something I should have done in the past.

Now the hunt is on for an office.

The remainder of this year is going to bad with patient volume and overhead expenses of overlapping 2 offices, etc. But 2023! That's going to be some good times.

 

[AD04]

That comment.
And the other threads glorifying private practice SEP-IRA and solo 401k as retirement vehicles over W2.

It was just a reminder that PP really is king, and the only real positive I could see is not dealing with payment/collections. But everything else for running a private practice I have dialed in, and a good assistant.

I just need to build up the practice. I'm optimistic this location will have greater growth than current. Plus, I won't have to grow that much as I already have a lot of loyal patients. More, so, just need to top off.

The idea of doing 4 consults or more in a day to build up a new practice... I just don't have the stamina to do that again. I'm making my stand with this practice. The BOSS says I have 2 years to make it hum, or she'll make me shut it down and go do an employed job. Even the thought of each consult I'd do is worth X dollars, but then seeing it as wRVUs, and knowing the flick of a pen, the admin could change the wRVU game over night.

I've tasted freedom. I can't ... I can't go back.

Even something as simple as vacation days. I don't want to have to ask. I want to go click click on my calendar and be done with it. No asking, just doing.

I have taken steps to consolidate my schedule so it will truly be 3 days clinical, rather than a more drawn out schedule in the whole week. It'll be nice to truly have a 3 day weekend. Can always expand into that if wanted in the future, but parsing out work versus non-work days is something I should have done in the past.

Now the hunt is on for an office.

The remainder of this year is going to bad with patient volume and overhead expenses of overlapping 2 offices, etc. But 2023! That's going to be some good times.

Your "boss" is very patient.

I'm not sure I agree that your decision is the right one. Not all administration is bad. For example, I wanted a stand up desk. Administration was informed. After 1 - 2 weeks, I got one. I didn't have to pay for one.

If for some reason it doesn't work out, in 1 year as employee, you would have made 3x what you made in private practice. And you would have learned more just by working in a different environment. And the solo 401k is good only if you're making enough profit to max it out. Your 401k match is guaranteed. How common is it to decrease $ / wRVU compared to insurance companies decreasing reimbursement? I don't think they're very common. I don't see the downside of switching.

You should test things out for yourself instead of listening to some random person on the forum. (This applies to what I write too.)

 

[painballer27]

Yeah Idk man this is rough. I'd probably go with the money

 

[calvnandhobbs68]

Your "boss" is very patient.

Yeah gotta agree with ya there.

I mean neither decision is the wrong one but the reasoning is a little goofy from the financial and even lifestyle side.
If you're telling the truth, you haven't netted more than 120K from PP/year for 3 years now.
You'd instantly be increasing your pay by 2.5x.
I don't get the distress about doing intakes because you said the 300K is guaranteed....so just try telling them you'll only do X amount of intakes per day (could probably even get it in writing), most places don't expect you to start off doing 5 intakes a day every day the first few weeks just cause you're new, that's the point of the salary guarantee.
PCPs are covering urgent calls, what made you think you wouldn't be able to take vacation when you want?
Solo 401k doesn't really matter that much if you can't actually maximize it...which would be hard to do on your current net/year. Actually employer matching 401k makes much more sense at lower income levels.

I mean you actually have to have enough money to buy a farm....

 

[painballer27]

Yeah I'm not gonna tell you what to do but you worked too hard to be making 120k a year... Do you take insurance with your private practice? I'm just trying to figure out how you aren't making more

 

[calvnandhobbs68]

Yeah I'm not gonna tell you what to do but you worked too hard to be making 120k a year

I agree he shouldn't be making 120k/year but also agree he probably shouldn't put a lot of stock in your opinion Mr. Medical Student who changed his screen name.

 

[nexus73]

I still say work at hospital 3 days and maintain PP 2 days for now. Best of both worlds.

 

[smalltownpsych]

I’ll comment as a private practice owner although obviously different perspective as I emphasize straight up therapy, but I do work alongside a Psych NP that is leaving lots of money on the table and working harder than me for less money even though she should be killing it. I am also a bit mystified at why you’re not hitting higher numbers and based on what I am seeing in my practice, I suspect that there might be some patient management skills to develop or improve. Our procedures are interpersonal and when patients perceive value they use our services more and when we set firm boundaries and clear expectations with patients, we can sift out the ones who will waste our time. Part of the gift of private practice is that I get to determine the policies and procedures to maximize revenue. I do not charge no show or late cancel fees, I just terminate them if they don’t show and are not committed to improvement and paying me for the help. Usually they quit after the first communication to them of the three no show policy. Pro tip: I only tell patients that are frustrating and non-compliant and demanding about the policy explicitly. My solid patients that I like, I work with them and they improve their attendance. It is always bad to implement policies that annoy good patients in order to try and get bad patients to do what we want.

I also think sales techniques are helpful, but maybe that’s because I put myself through undergrad by doing commission sales. I am always using affirmative language to set appointments and increase compliance with all aspects of treatment. I am really glad that you called about this “crisis” and i can’t wait to address it tomorrow. I can see you at either 8:00 am or 12:00. Which would you prefer? Also, since they are relieved they talked to me, usually about 5 to 10 max and they are happy I can get them in tomorrow, they are done at that point. This is also cash pay so part of what I market is ease of access and flexibility. What I find is that when I am flexible when I determine it to be appropriate and set boundaries when I determine it’s appropriate, I make more money and me and my patients are happier. In other words, I take charge of the interactions, I just don’t do it in a way that is disempowering or controlling the way some of my hapless parents of adolescents do. It’s called interpersonal effectiveness skills by Dr. Linehan.

 

[clausewitz2]

I’ll comment as a private practice owner although obviously different perspective as I emphasize straight up therapy, but I do work alongside a Psych NP that is leaving lots of money on the table and working harder than me for less money even though she should be killing it. I am also a bit mystified at why you’re not hitting higher numbers and based on what I am seeing in my practice, I suspect that there might be some patient management skills to develop or improve. Our procedures are interpersonal and when patients perceive value they use our services more and when we set firm boundaries and clear expectations with patients, we can sift out the ones who will waste our time. Part of the gift of private practice is that I get to determine the policies and procedures to maximize revenue. I do not charge no show or late cancel fees, I just terminate them if they don’t show and are not committed to improvement and paying me for the help. Usually they quit after the first communication to them of the three no show policy. Pro tip: I only tell patients that are frustrating and non-compliant and demanding about the policy explicitly. My solid patients that I like, I work with them and they improve their attendance. It is always bad to implement policies that annoy good patients in order to try and get bad patients to do what we want.

I also think sales techniques are helpful, but maybe that’s because I put myself through undergrad by doing commission sales. I am always using affirmative language to set appointments and increase compliance with all aspects of treatment. I am really glad that you called about this “crisis” and i can’t wait to address it tomorrow. I can see you at either 8:00 am or 12:00. Which would you prefer? Also, since they are relieved they talked to me, usually about 5 to 10 max and they are happy I can get them in tomorrow, they are done at that point. This is also cash pay so part of what I market is ease of access and flexibility. What I find is that when I am flexible when I determine it to be appropriate and set boundaries when I determine it’s appropriate, I make more money and me and my patients are happier. In other words, I take charge of the interactions, I just don’t do it in a way that is disempowering or controlling the way some of my hapless parents of adolescents do. It’s called interpersonal effectiveness skills by Dr. Linehan.

Right, authoritative is optimal v. authoritarian or permissive. One thing I started doing early on that I think was really helpful but that totally came from my own idiosyncratic preferences was scheduling follow-ups directly with the patient at the tail end of every appointment instead of handing them off to someone else to schedule. Unlike your situation I am not going to have a standing regular slot for most folks so it is not always a given a priori when I would normally follow-up with a particular person. I think transitioning from me to scheduling by an admin is a point of potential attrition; some percentage of people are going to say yes ro me and keep the appointment they agree to with me who might take weeks or months realistically to set things up if they have to talk to someone else.

 

[BiscoDisco]

I still say work at hospital 3 days and maintain PP 2 days for now. Best of both worlds.

What sort of hospital work do you do?

 

[painballer27]

I agree he shouldn't be making 120k/year but also agree he probably shouldn't put a lot of stock in your opinion Mr. Medical Student who changed his screen name.

I'll say it again: Regardless of my qualifications, most of what I have said on here is valid and accurate. But thats okay, you don't have to put stock in it because it wasn't directed at you. Why don't you go read your comic books and stop creeping my profile

 

[calvnandhobbs68]

I'll say it again: Regardless of my qualifications, most of what I have said on here is valid and accurate. But thats okay, you don't have to put stock in it because it wasn't directed at you. Why don't you go read your comic books and stop creeping my profile

If you’re going to post in the physician forums, you’d get a lot less shade thrown your way if you appropriately tagged yourself as a medical student instead of leaving it blank and trying to come off as someone with any helpful insights to offer around a career in this field. You have no idea if what you say is valid because it’s pretty much second hand info you’ve gotten off this forum.

The name/picture change thing just comes off as desperately trying to make people forget who you are and your run of constantly asking about how much money you could make every other day (which you seem to keep trying to get at in roundabout ways).

Sushi has a huge 9 page thread detailing exactly what his PP setup currently is, so make your way over there if you’re interested in the details of his practice.

 

[MedMan80]

You made the right choice, there's no guarantees with employed positions. Change of leadership and hospitals feeling they can replace us with NP's has lowered the leverage we have.

 

[nexus73]

What sort of hospital work do you do?

It's in reference to Sushi's job offer to be employed at a hospital clinic vs stay in private practice. I'm saying this rural hospital is probably desperate enough to let you do whatever you want, work 3 days for them and have guaranteed base salary/benefits, and 2 days a week private practice to maintain outside income and self-determination. And over time you he may find it's a nice split, or one is better than the other and migrate to one job only.

I'd assume a 3 day employed position at a hospital would pay at least 120K, if not closer to 150-180K, which sounds like more than he makes now, so the private practice is a bonus.

And you keep the benefit of an established outside job, so if the hospital makes changes to screw you over, you're not faced with building a practice from scratch, you are expanding an established practice from 2 days to 4-5 days a week.

These are really hard decisions to make though, and personal, so while it's interesting to throw our opinions into the ring, Sushi is the one to decide and I can see reasonable arguments both directions.

 

[smalltownpsych]

Right, authoritative is optimal v. authoritarian or permissive. One thing I started doing early on that I think was really helpful but that totally came from my own idiosyncratic preferences was scheduling follow-ups directly with the patient at the tail end of every appointment instead of handing them off to someone else to schedule. Unlike your situation I am not going to have a standing regular slot for most folks so it is not always a given a priori when I would normally follow-up with a particular person. I think transitioning from me to scheduling by an admin is a point of potential attrition; some percentage of people are going to say yes ro me and keep the appointment they agree to with me who might take weeks or months realistically to set things up if they have to talk to someone else.

Completely agree with scheduling being a potential point of attrition. I put more effort into that than any other aspect of the business, again probably from my sales background and the importance of getting a firm commitment. Don't want to leave it ambiguous with the customer saying they'll call you. In sales we called that waiting for the "be back bus" and we would laugh at the newer folk who counted on those "be back" sales that were not going to materialize.

On a related note, I signed up with a local NP for concierge primary care. I met her through a mutual friend and know that she is clearly struggling with her practice to the point that she hired a professional networker. So I met with her for a physical and she gave me a referral to get some labs done. This was two months ago and I haven't done it because I walked out of the office without an appointment for the blood draw or clear idea of what I was supposed to do next. The longer it goes the more likely i am to go a different direction. If she set something concrete up in the next day or so, I would have done it. She doesn't need professional networking. Focusing on acquisition and not retention is a huge mistake and leads to a lot of extra work and cost.

 

[Bartelby]

Focusing on acquisition and not retention is a huge mistake and leads to a lot of extra work and cost.

A great point. It also seems like happy patients tell others and thus the things that help retention can help acquisition too. And a panel of relatively stable and know follow ups is a lot easier to manage than a flood of new patients.

 

[forchinet121]

Completely agree with scheduling being a potential point of attrition. I put more effort into that than any other aspect of the business, again probably from my sales background and the importance of getting a firm commitment. Don't want to leave it ambiguous with the customer saying they'll call you. In sales we called that waiting for the "be back bus" and we would laugh at the newer folk who counted on those "be back" sales that were not going to materialize.

On a related note, I signed up with a local NP for concierge primary care. I met her through a mutual friend and know that she is clearly struggling with her practice to the point that she hired a professional networker. So I met with her for a physical and she gave me a referral to get some labs done. This was two months ago and I haven't done it because I walked out of the office without an appointment for the blood draw or clear idea of what I was supposed to do next. The longer it goes the more likely i am to go a different direction. If she set something concrete up in the next day or so, I would have done it. She doesn't need professional networking. Focusing on acquisition and not retention is a huge mistake and leads to a lot of extra work and cost.

Why would you see an NP for your primary care?

 

[painballer27]

If you’re going to post in the physician forums, you’d get a lot less shade thrown your way if you appropriately tagged yourself as a medical student instead of leaving it blank and trying to come off as someone with any helpful insights to offer around a career in this field. You have no idea if what you say is valid because it’s pretty much second hand info you’ve gotten off this forum.

The name/picture change thing just comes off as desperately trying to make people forget who you are and your run of constantly asking about how much money you could make every other day (which you seem to keep trying to get at in roundabout ways).

Sushi has a huge 9 page thread detailing exactly what his PP setup currently is, so make your way over there if you’re interested in the details of his practice.

Alright. I tagged myself appropriately. I also read Sushi's post. Good stuff thanks.

 

[docksan]

I'll say it again: Regardless of my qualifications, most of what I have said on here is valid and accurate. But thats okay, you don't have to put stock in it because it wasn't directed at you. Why don't you go read your comic books and stop creeping my profile

Gonna be hard for you to carve a positive name for yourself in this field if you're going to be that antagonistic.

 

[smalltownpsych]

Why would you see an NP for your primary care?

Because there are not enough docs in our town and I rarely go to see one anyway as I believe the best way to stay healthy is to stay away from doctors. That’s only about half in jest. I do need to get a colonoscopy though and get back to a bit healthier version of my plant based diet though. Sugar and flour and coconut oil are plant-based but not exactly healthy to load up on some of those. 😁

 

[Stagg737]

The idea of doing 4 consults or more in a day to build up a new practice... I just don't have the stamina to do that again. I'm making my stand with this practice. The BOSS says I have 2 years to make it hum, or she'll make me shut it down and go do an employed job. Even the thought of each consult I'd do is worth X dollars, but then seeing it as wRVUs, and knowing the flick of a pen, the admin could change the wRVU game over night.

The bolded is an easy fix with a one-line clause in your contract (employee will see no more than X new patients/consults in a day/week [without direct consent of Dr. Sushi and discussion of specific appointment time]). The wRVU point is more difficult, but that's why the recommendation to maintain at least part of your PP was there. If the employer suddenly switches gears you've got something to fall back on.

Your "boss" is very patient.

I'm not sure I agree that your decision is the right one. Not all administration is bad. For example, I wanted a stand up desk. Administration was informed. After 1 - 2 weeks, I got one. I didn't have to pay for one.

If for some reason it doesn't work out, in 1 year as employee, you would have made 3x what you made in private practice. And you would have learned more just by working in a different environment. And the solo 401k is good only if you're making enough profit to max it out. Your 401k match is guaranteed. How common is it to decrease $ / wRVU compared to insurance companies decreasing reimbursement? I don't think they're very common. I don't see the downside of switching.

You should test things out for yourself instead of listening to some random person on the forum. (This applies to what I write too.)

Sure, admin can be great and when they're desperate there's definitely a greater ability to make requests and demands. The desperation could also mean an inability to accommodate d/t lacking resources though. Someone else also mentioned administrative turnover. If this is a rural hospital that's relatively small, the turnover of very few staff can lead to major paradigm shifts and make the position look completely different.

 

[clausewitz2]

A great point. It also seems like happy patients tell others and thus the things that help retention can help acquisition too. And a panel of relatively stable and know follow ups is a lot easier to manage than a flood of new patients.

I see a surprisingly large number of married couples individually as patients, almost always one recommending me to the other. Some have split up but both kept me as their psychiatrist. In one situation I was seeing married couple and person one partner was having an affair with; this situation exploded as you might expect but I didn't lose any patients out of it. I feel like that's a decent vote of confidence.

I am basically full but I will see new patients who are a) referred by people I trust, b) people in the biz (physicians, therapists, etc), or c) someone who is important to an existing patient.

 

[AD04]

Sure, admin can be great and when they're desperate there's definitely a greater ability to make requests and demands. The desperation could also mean an inability to accommodate d/t lacking resources though. Someone else also mentioned administrative turnover. If this is a rural hospital that's relatively small, the turnover of very few staff can lead to major paradigm shifts and make the position look completely different.

All valid concerns. For anyone who wants to navigate through and climb up institutions, this is a necessary risk to take. People skills and diplomatic skills and understanding the dynamics of the relationship (mainly if you're adding or subtracting net value) all come into play. And for those who are successful, there is usually a payoff. Doing your own thing only gets you so far.

Part of the interview is also to assess administration to mitigate the risk. I focus on the here and now and will deal with unfavorable changes if or when that happens. Why worry about something that didn't happen yet (or may never happen)? With enough pay off, you can come out ahead even with setbacks from administration. Kind of like investing in stocks which can have higher drawdowns (vs bonds) but with higher expected return over the long-run.

In OPs case, the risk-reward profile of pay vs being screwed over by administration is overwhelmingly on the reward side. If he worked at the place for 1 year and was screwed over, he can have up to 2 years to bounce to another position and he'll break even compared to if he stayed at where he's at now. Most likely, he won't be screwed over and will have a long career there if he chooses. But if he is, he'll bounce back in 1 year or less which makes the new position the better financial choice.

 

[finalpsychyear]

All valid concerns. For anyone who wants to navigate through and climb up institutions, this is a necessary risk to take. People skills and diplomatic skills and understanding the dynamics of the relationship (mainly if you're adding or subtracting net value) all come into play. And for those who are successful, there is usually a payoff. Doing your own thing only gets you so far.

Part of the interview is also to assess administration to mitigate the risk. I focus on the here and now and will deal with unfavorable changes if or when that happens. Why worry about something that didn't happen yet (or may never happen)? With enough pay off, you can come out ahead even with setbacks from administration. Kind of like investing in stocks which can have higher drawdowns (vs bonds) but with higher expected return over the long-run.

In OPs case, the risk-reward profile of pay vs being screwed over by administration is overwhelmingly on the reward side. If he worked at the place for 1 year and was screwed over, he can have up to 2 years to bounce to another position and he'll break even compared to if he stayed at where he's at now. Most likely, he won't be screwed over and will have a long career there if he chooses. But if he is, he'll bounce back in 1 year or less which makes the new position the better financial choice.

All good points. My take work a little harder in the first year and do essentially both positions and keep the PP since it seemed doable to fit the case load into 2 days maybe 1.5 plus occasional Saturdays. Then as time passes maybe you add days to the PP by subtracting the employed days or vice versa. I've done this since middle of year 1 only to find myself having success at both parts where for me this is the ideal set up.

 

[AD04]

All good points. My take work a little harder in the first year and do essentially both positions and keep the PP since it seemed doable to fit the case load into 2 days maybe 1.5 plus occasional Saturdays. Then as time passes maybe you add days to the PP by subtracting the employed days or vice versa. I've done this since middle of year 1 only to find myself having success at both parts where for me this is the ideal set up.

I remember your setup from about 2.5 years ago. Any changes? Increase in pay from the job? Or growth in private practice? Or have you been intentionally keeping it small to reduce administrative burden of the practice?

 

[Liquid8]

A great point. It also seems like happy patients tell others and thus the things that help retention can help acquisition too. And a panel of relatively stable and know follow ups is a lot easier to manage than a flood of new patients.

I see a surprisingly large number of married couples individually as patients, almost always one recommending me to the other. Some have split up but both kept me as their psychiatrist. In one situation I was seeing married couple and person one partner was having an affair with; this situation exploded as you might expect but I didn't lose any patients out of it. I feel like that's a decent vote of confidence.

I am basically full but I will see new patients who are a) referred by people I trust, b) people in the biz (physicians, therapists, etc), or c) someone who is important to an existing patient.

This is pretty much how my practice grew without much effort on my behalf. Can remember seeing a child psychologist who wanted to refer a few of the parents of her patients to me, and one of those just so happened to be extremely active and vocal on her mothers' groups leading to an organic spread of new referrals. The other group of note flowed from an anxious/autistic/ADHD woman who was making a career change into IT, and this led to a bunch of referrals mainly for social anxiety/ASD. Have had a few patients recommend that their partners or adult children see me and agree that it is a huge vote of confidence.

 

[finalpsychyear]

I remember your setup from about 2.5 years ago. Any changes? Increase in pay from the job? Or growth in private practice? Or have you been intentionally keeping it small to reduce administrative burden of the practice?

Its been 5-6 years now which has gone quick. Moved into director role at job and PP has been solid. I enjoy the hybrid tele in person job the most since their is no headache involved with everything that goes along with PP to the point where I am even not sure I want to do the PP more than 1-2 more years. I would love my career to wind down somewhere in the next 5-10 years so i am just working to have structure but that will obviously be a large part based on the market recovering.

 

[AD04]

Its been 5-6 years now which has gone quick. Moved into director role at job and PP has been solid. I enjoy the hybrid tele in person job the most since their is no headache involved with everything that goes along with PP to the point where I am even not sure I want to do the PP more than 1-2 more years. I would love my career to wind down somewhere in the next 5-10 years so i am just working to have structure but that will obviously be a large part based on the market recovering.

Thanks for sharing. You're one of the few people who is working a job and running a private practice. And it is eye-opening to your thoughts about private practice. In 10 years, given my assumptions of your financial literacy and goal for FIRE, you can definitely wind down. Just don't lose half of it if your partner splits.