"rural"
I suspect this will be difficult.
Cash is hard to do in small cities or rural areas without a burgeoning economy. The local population is woefully underserved. One reason your salary is so low is because a large swaths of the patients are Medicare/Medicaid and can't afford anything else, and the service itself is likely losing money.
Cash in and of itself, however, would not be hard if you relocate to a well off suburb of Charlotte or Charleston and do some marketing. Nevertheless--I'm from there though don't practice there, and have explored options in the Carolinas-- it is apparent that the insurance taking group model is still fairly dominant. I would consider using this three month period to call some practice groups in the areas you are interested in to see if they are interested in taking on a partner track associate, and shop your resume around. Typically these groups have an overwhelming number of patients, and are happy to take you on as long as they do a fairly inequitable profit sharing to start, but if the managing partners are reasonable people they will eventually keep you. This is a better system IMHO if you need staff support for billing etc. One trick of the trade after talking to various people: I've found that PhD run groups to be more exploitative than MD run groups--just something to be mindful of--they typically don't bring on MD partners. This tendency is especially strong for young female MDs who don't negotiate as aggressively with old PhD owners , who are often old white men (sometimes women), and they don't run their business particularly well (as MDs and PhDs often have no sense of business) but have an overinflated sense of their value, when actually the current market dictum is that the MDs exceed PhD values BY FAR, especially in the South. People want meds, and are also far far less picky about their MD than their therapist. People tend to gender/age-sort for therapist, a tendency not found nearly as strongly for MDs. MDs also keep more patients for longer since they don't see them as frequently, hence serve as a deep pool for referrals on a recurrent basis, as people might need therapy only sporadically. I have a friend who took a locum part time with a PhD group getting 60:40 and is regretting it big time because literally she's giving them referrals from day one as opposed to the other way around. She's gonna do cash on the side soon. She's geri, too, and will probably take Medicare, but even with the cut with a biller she'll still probably make 2x on her own (99213+90833 ~ $150-175). As professionals trickle from the NE/California to "the New South", expectations also change, and it's not unusual now to have suburban Atlanta combined med/therapy practices that are pure cash.
You can do your own thing, and take a couple of commercial insurances. I have friends who do this. It's not *that* hard, though credentialing typically takes 3-6 months as well, so you might as well start now. You will fill immediately regardless of where you are, unless you stay in a small desolate town with mostly publicly insured. Thankfully insurance credentialing goes with location, not clinician. So you can in theory have two practice locations, and do cash at one and insurance at another. Given commercial real estate is dirt cheap in the south, I would consider that to start as well. The other thing is this is much less common in psychiatry but very common in primary care: membership based part insurance concierge direct care model. You charge $150 membership a month, and don't take anyone who isn't interested in at least monthly psychotherapy. Bill insurance only for whatever is reimbursed, but total revenue will be high with 50-100 patients. This is apparently 100% legal (
Concierge care | Medicare.gov), but it may be useful to get a special lawyer/service to draft the agreement for compliance.
Bottomline, if you are at somewhere like Greensboro or smaller, and you want to do cash, you should probably move to a bigger town and target professionals. You can still visit your parents on occasion with a 2-4 hour drive. As is with all things in life, location and marketing is absloute KEY to a successful cash practice.
Things are very local, FYI. Florida, for example is a totally different story. There are very few insurance groups down the east coastal areas all the way up to Boca. Everyone's cash. Miami psychiatrists charge just as much as LA psychiatrists. I think it has to do with South American influences--Argentinians for example have a very strong history of psychoanalysis and everyone who's wealthy has an analyst.
