New Cash Only Private Practice - Work in Progress

[FI-Prexa]

Hi everyone!

Long time lurker. Big fan of the previous private practice in progress threads, they have been immensely helpful to me in planning my private practice. I wanted to start a thread about me starting a small cash only private practice in hopes to gain some wisdom from the community and maybe to help someone else thinking about doing the same.

I am currently a full-time inpatient psychiatrist. Hopefully opening/beginning to schedule patients in the next 3 weeks.

Office:
- Currently renting a small office for $475 a month. Even though I only plan to start with 1 night per week (approximately 5PM to 9/10PM, the price was good and leaves options to get busier and customize my office as opposed to sub-leasing).
- Prefer to do in-person appointments, will patients be weirded out seeing me that late in the day?
- Its 5 minutes from my home which is awesome (current drive to main gig is killing me).
- Got furniture, two chairs for patients/family and one for me. A desk and coffee table.
- Will get a small business insurance policy for slips/falls risk.
- Just me, no employees.
- Will primarily communicate with patients via MyChart equivalent for Luminello, although will likely create a google voice phone tree for refills/non-urgent matters.

Accounting:
- Plan on doing my own taxes as a sole proprietor until revenue picks up enough to justify S-corp. Using YNAB to track revenue/expenses.
- Have separate business checking and credit card.

EMR:
- Signed up for Luminello. Very impressed with their tech support, especially with getting e-prescribing set up.
- Its about $1400 for the year which I am just going to pay in full.
- Plan is to screen patients with questionnaire that they can get from visiting my profile page. After they submit that, I'll review and give permission for them to fill out other practice forms, put credit card on file, ect. Once all those steps are done, they are able to access my calendar and schedule.

Malpractice:
- Got a quote for claims-made policy for part-time for about $1100 annually.
- Looked at several companies but The Doctor's Company was the only one that was prompt and got back to me within a reasonable time. They are flexible in that they will adjust coverage as I get busier.

Fees:
- I am still trying to figure out what to charge. I would rather build slowly with the right type of patients and price point than to fill quickly. Working full time at main gig gives me luxury of time I guess. Although, I would like this practice to be established enough by the time my contract is up in about 3 years so I can walk away from main gig if needed.
- I do want my documentation time to be compensated. So hourly rate would = (face to face time + documentation).
- I am thinking to start at $400/hour.
- I like psychopharmacology but would also provide supportive/CBT/psychodynamic therapy during follow-ups to mix things up.
- Looking at 30 minute follow-up. So (30 minute follow-up + 15 minutes documentation = 0.75 hours * $400/hour = $300)
- Intakes would be 1.5 hours to add to concierge experience + 30 minutes documentation so 2 hours total. $800?
- I think I can provide good treatment and a personalized experience, however am a new attending so wondering if patients would balk at that price.
- I am in more affluent suburb of a medium sized Midwest metro area
- I'm ok with building slowly as I can only do 5 hours per week on one week night for the first year or so. May open to additional evening if things are going well.

Advertising:
- Thinking of starting with Psychology Today. Can link my Luminello profile page directly there, potential patients can then access and fill out screening questionnaire.
- I have a older mentor who is willing to put me in touch with his friends who need places to refer patients. I am just worried about filling too quickly and not being able to handle volume with my limited hours so may hold off for now.

I am currently finishing up getting malpractice and starting to work on screening forms and policy/practice forms. Appreciate your thoughts! Will keep you posted on how things are going.

FI-Prexa

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[Meyer-Overton]

How much are you making at your main gig?

 

[Sushirolls]

Congratulations! Exciting times. I look forward to future posts!

 

[sighchiatry]

Hi everyone!

Long time lurker. Big fan of the previous private practice in progress threads, they have been immensely helpful to me in planning my private practice. I wanted to start a thread about me starting a small cash only private practice in hopes to gain some wisdom from the community and maybe to help someone else thinking about doing the same.

I am currently a full-time inpatient psychiatrist. Hopefully opening/beginning to schedule patients in the next 3 weeks.

Office:
- Currently renting a small office for $475 a month. Even though I only plan to start with 1 night per week (approximately 5PM to 9/10PM, the price was good and leaves options to get busier and customize my office as opposed to sub-leasing).
- Prefer to do in-person appointments, will patients be weirded out seeing me that late in the day?
- Its 5 minutes from my home which is awesome (current drive to main gig is killing me).
- Got furniture, two chairs for patients/family and one for me. A desk and coffee table.
- Will get a small business insurance policy for slips/falls risk.
- Just me, no employees.
- Will primarily communicate with patients via MyChart equivalent for Luminello, although will likely create a google voice phone tree for refills/non-urgent matters.

Accounting:
- Plan on doing my own taxes as a sole proprietor until revenue picks up enough to justify S-corp. Using YNAB to track revenue/expenses.
- Have separate business checking and credit card.

EMR:
- Signed up for Luminello. Very impressed with their tech support, especially with getting e-prescribing set up.
- Its about $1400 for the year which I am just going to pay in full.
- Plan is to screen patients with questionnaire that they can get from visiting my profile page. After they submit that, I'll review and give permission for them to fill out other practice forms, put credit card on file, ect. Once all those steps are done, they are able to access my calendar and schedule.

Malpractice:
- Got a quote for claims-made policy for part-time for about $1100 annually.
- Looked at several companies but The Doctor's Company was the only one that was prompt and got back to me within a reasonable time. They are flexible in that they will adjust coverage as I get busier.

Fees:
- I am still trying to figure out what to charge. I would rather build slowly with the right type of patients and price point than to fill quickly. Working full time at main gig gives me luxury of time I guess. Although, I would like this practice to be established enough by the time my contract is up in about 3 years so I can walk away from main gig if needed.
- I do want my documentation time to be compensated. So hourly rate would = (face to face time + documentation).
- I am thinking to start at $400/hour.
- I like psychopharmacology but would also provide supportive/CBT/psychodynamic therapy during follow-ups to mix things up.
- Looking at 30 minute follow-up. So (30 minute follow-up + 15 minutes documentation = 0.75 hours * $400/hour = $300)
- Intakes would be 1.5 hours to add to concierge experience + 30 minutes documentation so 2 hours total. $800?
- I think I can provide good treatment and a personalized experience, however am a new attending so wondering if patients would balk at that price.
- I am in more affluent suburb of a medium sized Midwest metro area
- I'm ok with building slowly as I can only do 5 hours per week on one week night for the first year or so. May open to additional evening if things are going well.

Advertising:
- Thinking of starting with Psychology Today. Can link my Luminello profile page directly there, potential patients can then access and fill out screening questionnaire.
- I have a older mentor who is willing to put me in touch with his friends who need places to refer patients. I am just worried about filling too quickly and not being able to handle volume with my limited hours so may hold off for now.

I am currently finishing up getting malpractice and starting to work on screening forms and policy/practice forms. Appreciate your thoughts! Will keep you posted on how things are going.

FI-Prexa

Don't get claims made insurance. Get occurrence based insurance.

 

[FI-Prexa]

How much are you making at your main gig?

Main gig is $250-300,000 depending on productivity.

 

[FI-Prexa]

Don't get claims made insurance. Get occurrence based insurance.

My thought is that my main passion is outpatient and want to ultimately be self-employed. I will likely always have a self employed private practice (whether side gig or main gig) until I retire from medicine. Even if financially independent/retired early, I would keep a day or half day of clinic. Occurrence was like $5-6000 for part-time. I felt it would be cheaper to drop $15,000 on a tail if absolutely needed in the future.

 

[FI-Prexa]

Congratulations! Exciting times. I look forward to future posts!

Thanks! Your thread was a big inspiration.

 

[wolfvgang22]

Looks like a great start! No one is going to be "weirded out" by appointment times after 5pm. The patients with jobs will love not having to take time off work, and some of the others don't normally get out of bed until noon anyway.

 

[Jules A]

Congratulations and best wishes.
With cash only unless directly taking over someone else’s practice it is doubtful you will fill up too quickly but if so that isn’t the worse problem one could have. Starting 1 evening per week sounds ideal and will increase nicely over your 3 year timeframe. I would price yourself similarly to other psychiatrists in your area. Definitely offer virtual in addition to office. About 75% of mine prefer virtual and closer to 90% want virtual after the initial in office evaluation.

 

[FI-Prexa]

Congratulations and best wishes.
With cash only unless directly taking over someone else’s practice it is doubtful you will fill up too quickly but if so that isn’t the worse problem one could have. Starting 1 evening per week sounds ideal and will increase nicely over your 3 year timeframe. I would price yourself similarly to other psychiatrists in your area. Definitely offer virtual in addition to office. About 75% of mine prefer virtual and closer to 90% want virtual after the initial in office evaluation.

Yeah makes sense. I will definitely want to offer telehealth after initial in-person, even though my preference would be following up in-person. I will probably reach out to my malpractice provider before they finalize the quote and see if possibility of 50% telehealth impacts quote. Or do they just mostly care about your initial appointments?

 

[splik]

- Looking at 30 minute follow-up. So (30 minute follow-up + 15 minutes documentation = 0.75 hours * $400/hour = $300)

I don't see how it could routinely take you 15 minutes to document a follow up visit. You're screwed before you even start if this is the case. It should take 2-3 mins on average and you can do 25min appointment and have some time in between appts to document. Your fees should be set based on how much you want to make/hours worked minus expenses accounting for what the market will bear for someone of your experience and specialties in your locality. 300 for a follow up is 600/hr. In some areas that is standard, whereas in other areas it would be very high. You need to take that into account.

 

[forchinet121]

400/hr seems high though right? Unless you’re in a HCOL area? Very interested though keep updating this thread you will provide a lot of inspiration!

 

[FI-Prexa]

I don't see how it could routinely take you 15 minutes to document a follow up visit. You're screwed before you even start if this is the case. It should take 2-3 mins on average and you can do 25min appointment and have some time in between appts to document. Your fees should be set based on how much you want to make/hours worked minus expenses accounting for what the market will bear for someone of your experience and specialties in your locality. 300 for a follow up is 600/hr. In some areas that is standard, whereas in other areas it would be very high. You need to take that into account.

Thanks for the reply! Yeah I agree 15 minutes is likely a gross overestimation. I wanted to do cash only specifically to avoid the bloated documentation insurance requires haha. On further thought, if aiming for $400/hour, 30 minute follow up at $200 and 90 minute initial at $600 makes sense.

 

[FI-Prexa]

400/hr seems high though right? Unless you’re in a HCOL area? Very interested though keep updating this thread you will provide a lot of inspiration!

Based on my research of the area, its on the higher side. But for me, that is a rate that I feel my after hours after a full time job are worth. My biggest concern is getting someone in the door if there is sticker shock. I'm hopeful that if someone takes a chance on me, the quality of the interaction will keep them coming back. Average waiting times in my area are 3+ months.

 

[Celexa]

Based on my research of the area, its on the higher side. But for me, that is a rate that I feel my after hours after a full time job are worth. My biggest concern is getting someone in the door if there is sticker shock. I'm hopeful that if someone takes a chance on me, the quality of the interaction will keep them coming back. Average waiting times in my area are 3+ months.

People only have one intake. You can discount the intake (pick your mechanism/framing) to reduce the initial sticker shock. You make most of your money on follow ups.

30 min follow up slots/90 min intakes are my plan, with 30 mins of the intake for review of prior records and intake paperwork and 5 min at the end of the slots for documentation and any follow up tasks. Agree with splik that in a cash only private practice follow up documentation should be very efficient.

 

[calvnandhobbs68]

I’d look around to see what people are charging around you. As someone who has lived in multiple medium sized midwestern metro areas, unless it's Chicago (which isn't medium sized) I suspect 800 bucks for an intake and 300 bucks for a 30min followup may be more than other cash practices may be charging, especially if you’re primarily med focused. People can go to an NP and get Prozac or lamictal filled. You'll likely need some kind of niche selling point/psychotherapy approach to make people willing to pay those rates. 600 (for a 90min intake)/200 like you noted above may be more in line.

 

[Celexa]

I’d look around to see what people are charging around you. As someone who has lived in multiple medium sized midwestern metro areas, unless it's Chicago (which isn't medium sized) I suspect 800 bucks for an intake and 300 bucks for a 30min followup may be more than other cash practices may be charging, especially if you’re primarily med focused. People can go to an NP and get Prozac or lamictal filled. You'll likely need some kind of niche selling point/psychotherapy approach to make people willing to pay those rates. 600 (for a 90min intake)/200 like you noted above may be more in line.

An attending I respect a lot, who charged $$$$ (over market for our area) gave the very wise advice that often, he's the only psychiatrist people can get in touch with. People are desperate and they will pay if you provide a worthwhile product.

In our field 'worthwhile' is often the low, low bar of simply genuinely listening to the patient, asking questions that show you were listening, and reply to calls/messages within a few business days.

If the OP has local referral sources (which it sounds like they do) I bet they'll have success if they can do the above even charging above 'market'.

And what's market anyway? Most psychiatrists are terrible at valuing their own work and feel guilty about charing for our real value. Actual data on the true cash market is real thin on the ground and you don't know what your area will sustain until you try.

 

[clausewitz2]

An attending I respect a lot, who charged $$$$ (over market for our area) gave the very wise advice that often, he's the only psychiatrist people can get in touch with. People are desperate and they will pay if you provide a worthwhile product.

In our field 'worthwhile' is often the low, low bar of simply genuinely listening to the patient, asking questions that show you were listening, and reply to calls/messages within a few business days.

If the OP has local referral sources (which it sounds like they do) I bet they'll have success if they can do the above even charging above 'market'.

And what's market anyway? Most psychiatrists are terrible at valuing their own work and feel guilty about charing for our real value. Actual data on the true cash market is real thin on the ground and you don't know what your area will sustain until you try.

I make a point of responding to my private practice clients' portal messages by end of the next business day, and you would not believe how stunned and absurdly grateful some people are to experience this. Evince genuine curiosity in peoples' experience and you will have repeat customers for sure. It is also way, way easier to actually listen and be responsive to patients if you aren't deluged with them, which in turn means you can charge more, which lowers the financial pressure to see more . . . a virtuous cycle.

 

[Sushirolls]

I'm responding to my luminello messages ~80-90% same day

 

[Celexa]

I'm responding to my luminello messages ~80-90% same day

The danger in replying too soon is they start to think you're on call to answer quickly all the time. I target at least one business day later for anything not a flat out emergency because of this.

 

[Sushirolls]

I've had that fear, but so far it hasn't been an issue or 'abused.' When things get back and forth, I simply say we need to really talk in an appointment.

 

[TheRightMedication]

One of the many advantages of longer appointments, and an understanding that you're always doing at least some psychotherapy, is that misuse of lines of communication can be discussed directly in therapy. I have one particularly challenging client for whom that can be the main thing we talk about sometimes.

It also opens the door for patients to say, hey, I was pretty upset when it took you 3 days to respond, and you can deal with the patient side of it too without it festering.

I tell people to expect 48 hour turnaround on business days, and can usually make it same day. Has worked well. Early in my practice when I had to focus on my main employed position it could take a few days and my experience there was it was just bad business, and I think patients felt uncared for.

 

[FI-Prexa]

Update:

Practice now live, advertising through Psychology Today which then links to my site/pre-screen. Have had some traffic through Psychology Today and my site. Up for about a week now (although just added a profile pic today). Only resulted in 1 phone call thus far. Wife calling for husband with ADHD that PCP feels needs urgently treated and a history of substance use. Likely too many red flags, although was tempting due to not having any other leads right now. No other consultation requests.

I did stick with $400/hr. $200 for 30 minute follow-up with therapy and $600 for initial 90 minute consultation. Expensive, but not going to lower rates quite yet. I do feel that I deliver a premium experience so hopefully slowly word of mouth will produce new referrals.

Leveraging some referral sources through a mentor, will wait to see how those turn out.

I also thought about reaching out to concierge internal medicine/family medicine practices in the area and introducing myself.

Office is all set up.

 

[vanfanal]

Just keep swimming… 🎶

 

[jbomba]

Update:

Practice now live, advertising through Psychology Today which then links to my site/pre-screen. Have had some traffic through Psychology Today and my site. Up for about a week now (although just added a profile pic today). Only resulted in 1 phone call thus far. Wife calling for husband with ADHD that PCP feels needs urgently treated and a history of substance use. Likely too many red flags, although was tempting due to not having any other leads right now. No other consultation requests.

I did stick with $400/hr. $200 for 30 minute follow-up with therapy and $600 for initial 90 minute consultation. Expensive, but not going to lower rates quite yet. I do feel that I deliver a premium experience so hopefully slowly word of mouth will produce new referrals.

Leveraging some referral sources through a mentor, will wait to see how those turn out.

I also thought about reaching out to concierge internal medicine/family medicine practices in the area and introducing myself.

Office is all set up.

What kind of forms/tools do you use to pre-screen?

 

[FI-Prexa]

Just keep swimming… 🎶

Lol for sure. I know doing this is not for the light hearted. Just got to stick with it, but it is definitely humbling at times.

 

[FI-Prexa]

What kind of forms/tools do you use to pre-screen?

Its just a generic questionnaire asking about current concerns/symptoms, previous psychiatric history, current/previous substance use, current controlled substance scripts, whether they are looking for medication, therapy or both.

When they get into the portal following approval there will be PHQ-9, GAD-7 and such. As well as policies for the practice. First consultation does not establish patient-doctor relationship, will discuss plans to continue treatment from there if its a good fit.

 

[forchinet121]

Very good keep it up!! Looking forward to future updates we are all rooting for you!!

 

[FI-Prexa]

Update:

Tomorrow marks 2 weeks since I have been actively advertising. In addition to my Psychology Today page and Luminello profile being live, I have called 4-5 concierge type internal medicine practices to introduce myself. They seemed excited/interested. I also tapped into a referral source from another psychiatrist introduced to me by a mentor.

So far only two phone calls. One which had many red flags as detailed in my previous update and one with red flags + couldn't afford the rates. There have been about 89 clicks on my Psychology Today page and 15 visits to my Luminello profile.

For those that use Luminello, I realized it requires people to create a login prior to submitting the referral request, I wonder if this is creating too much friction for people. I have not gotten any referrals submitted yet. I wonder if most are looking for insurance.

I did decrease my 90 minute intake to $450. 30 minute follow-up is still $200.

Business cards arrived, I plan on stopping by non-concierge PCP offices after work and dropping off card/introducing self.

Getting a little discouraged that in 2 weeks I have not gotten 1 viable referral yet. Will keep hustling. Open to critiques and suggestions from those more experienced!

 

[troutscout]

Update:

Tomorrow marks 2 weeks since I have been actively advertising. In addition to my Psychology Today page and Luminello profile being live, I have called 4-5 concierge type internal medicine practices to introduce myself. They seemed excited/interested. I also tapped into a referral source from another psychiatrist introduced to me by a mentor.

So far only two phone calls. One which had many red flags as detailed in my previous update and one with red flags + couldn't afford the rates. There have been about 89 clicks on my Psychology Today page and 15 visits to my Luminello profile.

For those that use Luminello, I realized it requires people to create a login prior to submitting the referral request, I wonder if this is creating too much friction for people. I have not gotten any referrals submitted yet. I wonder if most are looking for insurance.

I did decrease my 90 minute intake to $450. 30 minute follow-up is still $200.

Business cards arrived, I plan on stopping by non-concierge PCP offices after work and dropping off card/introducing self.

Getting a little discouraged that in 2 weeks I have not gotten 1 viable referral yet. Will keep hustling. Open to critiques and suggestions from those more experienced!

Do you have a website? A niche? Did you create a google business profile (ie is your practice geographically searchable)?
You need to make it super streamlined for how people book an intake with you. Do you have them request an intro phone call first?
And as a whole, things will take time.

 

[clozareal]

Update:

Tomorrow marks 2 weeks since I have been actively advertising. In addition to my Psychology Today page and Luminello profile being live, I have called 4-5 concierge type internal medicine practices to introduce myself. They seemed excited/interested. I also tapped into a referral source from another psychiatrist introduced to me by a mentor.

So far only two phone calls. One which had many red flags as detailed in my previous update and one with red flags + couldn't afford the rates. There have been about 89 clicks on my Psychology Today page and 15 visits to my Luminello profile.

For those that use Luminello, I realized it requires people to create a login prior to submitting the referral request, I wonder if this is creating too much friction for people. I have not gotten any referrals submitted yet. I wonder if most are looking for insurance.

I did decrease my 90 minute intake to $450. 30 minute follow-up is still $200.

Business cards arrived, I plan on stopping by non-concierge PCP offices after work and dropping off card/introducing self.

Getting a little discouraged that in 2 weeks I have not gotten 1 viable referral yet. Will keep hustling. Open to critiques and suggestions from those more experienced!

It took me about 1-2 months to get my first intake actually scheduled. I'm also cash only. I would encourage you to reach out to other psychiatrists in the area who are full and therapists in the area.

For therapists, I market myself as "if you have a patient who you've been doing therapy with for depression/anxiety/ADHD/panic/whatever and they're not getting better after a few months or you've hit a wall in how much you think you can help them, send them my way for a medication evaluation that may help them more effectively utilize your therapy services."

Once you get your first patient, talk to their therapist and PCP. Tell them that you are open to taking referrals and will send referrals their way if they want it and you think its appropriate. The more patients you see, the more chances you'll have to tap into their care team for referrals, and it snowballs from there.

I also use Luminello and found that patients who don't want to make a login or use Luminello are patients I typically don't want. I want them to be able to send me a message for refill requests. I want them to utilize the online calendar self-scheduling system. I hate doing those things via phone or email. It saves on time. If they can make it through the screening form and make an account, it's more likely that they are motivated to see you.

Good luck and keep on going!

 

[Sushirolls]

I also use Luminello and found that patients who don't want to make a login or use Luminello are patients I typically don't want. I want them to be able to send me a message for refill requests. I want them to utilize the online calendar self-scheduling system. I hate doing those things via phone or email. It saves on time. If they can make it through the screening form and make an account, it's more likely that they are motivated to see you.

Good luck and keep on going!

^That

I am insurance based and when I opened, I only had 11 consults in first 8 weeks of being open. It can go slow.
Luminello is your friend, lean into.
I've had a lot of patients fill out all their paperwork in matters of minutes, in same day, and scheduled up just as fast. Decide now, to lean into luminello as means to accentuate the practice or, go other direction you talk and schedule people, and luminello is minimally used but more of a limited repository for your notes...

 

[Jules A]

It can be slow going at first. I only had 4 patients in my first month, 2 my second month and 6 my third month. In the beginning picking up the phone and spending a few minutes with the prospective patient seemed helpful to reel in a few who were on the fence. I'm busy enough now that everything goes to voicemail and unless a psychiatrist referral or someone who really sounds like a call back is necessary I respond quickly with a text asking for their email to send office documents and upcoming openings. The voice mail definitely results in some losses but I don't have the time or inclination to answer the phone at this point and since most are inquires from other offices their therapist etc. has told them the drill so it isn't a matter of them shopping around as much as contacting me for an actual appointment.

 

[MedMan80]

I plan to jump to PP in the future, ideally I'd work some sort of gig while the practice is building but OP don't you have a non-compete from your main gig? Or are you geographically located away from it? btw, keep your head up, patience is a virtue and I'm sure it'll pickup

 

[FI-Prexa]

I made it very clear (while remaining professional and collegial, of course) at the first interview that I would not accept a contract that had a non-compete or any restriction on outside practice of outpatient psychiatry. The only stipulation is that if I pick up additional inpatient shifts, it needs to be in-house, not with our competitor, which seems fair as I'm W-2. The key is that I really was willing to walk away over it.

 

[surfguy84]

Is it reasonable for an outpatient group to preclude you from starting your own practice concurrently?

 

[forchinet121]

Is it reasonable for an outpatient group to preclude you from starting your own practice concurrently?

I mean of course it is you’re literally stealing patients from their practice..we need to be reasonable here

 

[1edyfirel]

Is it reasonable for an outpatient group to preclude you from starting your own practice concurrently?

Depends on the outpatient setting. Lots of outpatient docs at the VA also have their own PPs, sometimes with academics too (though that gets hairy because they often request a big cut). Ive also seen it frequently with doctors working outpatient at county jobs, FQHCs. But if you’re employed by a private group doing outpatient, they won’t love you also having your own PP on the side.

 

[surfguy84]

I mean of course it is you’re literally stealing patients from their practice..we need to be reasonable here

I'm not sure it's that black and white.

 

[forchinet121]

I'm not sure it's that black and white.

I mean unless you’re setting up a practice an hour away, they’re not gonna want you to steal their patients

 

[Bartelby]

I mean unless you’re setting up a practice an hour away, they’re not gonna want you to steal their patients

In my mind "stealing their patients" would be something like telling a new patient at the practice "hey, come over to see me at my private practice and I'll charge you 20 percent less!" Considering every potential patient within a couple hours of the practice "their patient" seems extreme.

That said, it's less about what's fair than about what they can get away with. You just have to run the numbers and decide if that kind of non-compete works for you.

 

[Desired Member]

Only resulted in 1 phone call thus far. Wife calling for husband with ADHD that PCP feels needs urgently treated and a history of substance use. Likely too many red flags, although was tempting due to not having any other leads right now.

 

[ElanaMD]

Hey FI-Prexa, congrats on starting your practice!

I can tell from your original post that you already have avoided one of the most common mistakes people make, which is starting with a a pricey office/expensive software solutions/too much overhead. You're also on point that you don't need to incorporate right off the bat. So many people I talk to get really focused on coming up with a creative practice name and incorporating with that name on day one, whereas it often doesn't make sense financially to incorporate until your second year of practice, when you're probably making enough money to reap the tax benefits of incorporation and it's worth the extra expense to pay for incorporation and an accountant to do your now more complicated taxes.

I saw someone comment on the claims vs occurrence based insurance -- yes it's true that with claims-based insurance you may have to pay for a tail policy at some point (often you don't have to pay for the tail if you are retiring at a minimum age), but a tail policy isn't THAT expensive, whereas an occurrence policy is typically extremely expensive, and you may be paying it for decades. I and everyone I know in PP goes with a claims-based policy. I was even in the position where I had to stop my policy for a period of time because I was on medical leave, and my insurance (MIEC) worked with me and let me pause it without paying a tail and then reactivate it when I was better.

Just three quick comments before I get into the meat of my response. First, these days psychiatry in private practice has really moved to tele, or at least hybrid in person + tele. So many patients prefer it (especially the higher functioning ones who tend to see PP psychiatrists) that I would advise you to consider seeing patients for in person for the initial, but then offering the option of tele for follow ups. From a marketing perspective, you can also fill faster when you do this because you can pull from a larger geographic area for your patient panel, because patients don't have to worry about driving to see you for every appointment. This will also make it easier to specialize or niche down should you desire to in the future -- again because you can pull your patients from a larger geographic area. Second comment -- you may find once you start filling (which you will) that it's kind of tricky to try to squish your patients all in one day.

Third comment -- the way you describe doing your screening in Luminello seems overly cumbersome for the patient. I think the best way to pre-screen patients is to have patients fill out an online contact form (it's much easier to make sure your patients know your fees over email first, rather that end up on the phone with people for whom your fees are a nonstarter), and then get on a quick phone call to build rapport and communicate your value (it's a skill set that you will grow making sure these phone calls don't go on forever), and then schedule the patient from a phone call.

Okay, now on to the main point I wanted to make -- you are worrying about filling way to prematurely and you lowered your fees too soon. There are 4 basic psychological stages to building a PP that everyone goes through:

0-3 months: Crippling terror - "This won't work, I'll never fill, no one will pay my fees, I should give up, I should cut my fees in half."
3-6 months: Moderate anxiety - "Okay I got a few patients, but they're not ideal patients, I don't know how to set boundaries, can I fire patients? I'll never be able to manage this"
6-12 months: Early confidence - "Okay this is staring to work... I'm not full yet, but I see how I could eventually be successful"
12+ months: Cruising

For the first six months your main task is not listening to your internal voice of anxiety. The reason you don't have patients yet is because 1) it takes time, and 2) you should be doing more to market. Psychology Today is great (I think it's one of the cheapest, highest yield way to get patients), but you could be doing a lot more with networking and referrals. You talked to five therapists and don't have any patients yet? Talk to a hundred and then get back to me. You're also right that concierge MDs are probably better referral sources than therapists. Therapists don't typically have large patient panels, and they just won't have as many referrals to potentially send you. They obviously also won't send you referrals you can do therapy with, and being able to do therapy is one of the joys of private practice. You also will fill faster with a smaller patient panel if you do therapy along with med management -- it's just math, since you're seeing those patients more frequently and for longer appointments.

I actually think one of the highest yield referral sources is connecting with another psychiatrist who is older/more established (maybe like your mentor) who is FULL and needs somewhere to send their overflow. Don't just send them a template email -- send them the nicest email ever sent in the history of humanity and offer to bring them lunch to their office or pay for an hour of supervision and then ask them advice about practice building. Even if you don't ask directly they will want to help you and will start sending you patients.

Let me just speak to fees for a second -- I know people will say all sorts of rules about looking at your competition/the market rate when deciding your fees, or that you shouldn't charge more than someone more experienced, or that you can't charge XYZ in the Midwest or whatever, but none of that is true. The difference between a psychiatrist who charges $300/hr and $1000/hr (or whatever amount) ISN'T CLINICAL SKILL. It's positioning and marketing. At a certain point we're all clinically "good enough." I know people may criticize that marketing is a dirty word, but marketing is just COMMUNICATING. How well do you speak to the internal fears and problems of your target market, and how well do you communicate that you will solve their problems? Your website should be the main place where you are communicating your value for potential patients, so that by the time they are calling you they are already 90% sold. Patients who pay high fees aren't stupid -- they're value driven.

I think your fees (your original fees) are totally reasonable. I know people in the Midwest who charge that amount and more. Your key task is to manage your anxiety, challenge your assumptions and BE PATIENT. Like someone else said, you have a job and income so you don't need to grow fast for any external reason -- patience is your friend. Trust me, the patience and work you put in will be totally worth it. Private practice is the best, especially when you aren't working with insurance and have total autonomy over your schedule, your patients, and the kind of care you deliver.

I hope this helps and I wish you the best with your practice!

 

[wanderer534]

You could try ZocDoc for advertising too. I'm not sure about their fees to be listed as a healthcare provider.

Thanks for posting your journey and being transparent. I look forward to your updates!

 

[forchinet121]

Hey FI-Prexa, congrats on starting your practice!

I can tell from your original post that you already have avoided one of the most common mistakes people make, which is starting with a a pricey office/expensive software solutions/too much overhead. You're also on point that you don't need to incorporate right off the bat. So many people I talk to get really focused on coming up with a creative practice name and incorporating with that name on day one, whereas it often doesn't make sense financially to incorporate until your second year of practice, when you're probably making enough money to reap the tax benefits of incorporation and it's worth the extra expense to pay for incorporation and an accountant to do your now more complicated taxes.

I saw someone comment on the claims vs occurrence based insurance -- yes it's true that with claims-based insurance you may have to pay for a tail policy at some point (often you don't have to pay for the tail if you are retiring at a minimum age), but a tail policy isn't THAT expensive, whereas an occurrence policy is typically extremely expensive, and you may be paying it for decades. I and everyone I know in PP goes with a claims-based policy. I was even in the position where I had to stop my policy for a period of time because I was on medical leave, and my insurance (MIEC) worked with me and let me pause it without paying a tail and then reactivate it when I was better.

Just three quick comments before I get into the meat of my response. First, these days psychiatry in private practice has really moved to tele, or at least hybrid in person + tele. So many patients prefer it (especially the higher functioning ones who tend to see PP psychiatrists) that I would advise you to consider seeing patients for in person for the initial, but then offering the option of tele for follow ups. From a marketing perspective, you can also fill faster when you do this because you can pull from a larger geographic area for your patient panel, because patients don't have to worry about driving to see you for every appointment. This will also make it easier to specialize or niche down should you desire to in the future -- again because you can pull your patients from a larger geographic area. Second comment -- you may find once you start filling (which you will) that it's kind of tricky to try to squish your patients all in one day.

Third comment -- the way you describe doing your screening in Luminello seems overly cumbersome for the patient. I think the best way to pre-screen patients is to have patients fill out an online contact form (it's much easier to make sure your patients know your fees over email first, rather that end up on the phone with people for whom your fees are a nonstarter), and then get on a quick phone call to build rapport and communicate your value (it's a skill set that you will grow making sure these phone calls don't go on forever), and then schedule the patient from a phone call.

Okay, now on to the main point I wanted to make -- you are worrying about filling way to prematurely and you lowered your fees too soon. There are 4 basic psychological stages to building a PP that everyone goes through:

0-3 months: Crippling terror - "This won't work, I'll never fill, no one will pay my fees, I should give up, I should cut my fees in half."
3-6 months: Moderate anxiety - "Okay I got a few patients, but they're not ideal patients, I don't know how to set boundaries, can I fire patients? I'll never be able to manage this"
6-12 months: Early confidence - "Okay this is staring to work... I'm not full yet, but I see how I could eventually be successful"
12+ months: Cruising

For the first six months your main task is not listening to your internal voice of anxiety. The reason you don't have patients yet is because 1) it takes time, and 2) you should be doing more to market. Psychology Today is great (I think it's one of the cheapest, highest yield way to get patients), but you could be doing a lot more with networking and referrals. You talked to five therapists and don't have any patients yet? Talk to a hundred and then get back to me. You're also right that concierge MDs are probably better referral sources than therapists. Therapists don't typically have large patient panels, and they just won't have as many referrals to potentially send you. They obviously also won't send you referrals you can do therapy with, and being able to do therapy is one of the joys of private practice. You also will fill faster with a smaller patient panel if you do therapy along with med management -- it's just math, since you're seeing those patients more frequently and for longer appointments.

I actually think one of the highest yield referral sources is connecting with another psychiatrist who is older/more established (maybe like your mentor) who is FULL and needs somewhere to send their overflow. Don't just send them a template email -- send them the nicest email ever sent in the history of humanity and offer to bring them lunch to their office or pay for an hour of supervision and then ask them advice about practice building. Even if you don't ask directly they will want to help you and will start sending you patients.

Let me just speak to fees for a second -- I know people will say all sorts of rules about looking at your competition/the market rate when deciding your fees, or that you shouldn't charge more than someone more experienced, or that you can't charge XYZ in the Midwest or whatever, but none of that is true. The difference between a psychiatrist who charges $300/hr and $1000/hr (or whatever amount) ISN'T CLINICAL SKILL. It's positioning and marketing. At a certain point we're all clinically "good enough." I know people may criticize that marketing is a dirty word, but marketing is just COMMUNICATING. How well do you speak to the internal fears and problems of your target market, and how well do you communicate that you will solve their problems? Your website should be the main place where you are communicating your value for potential patients, so that by the time they are calling you they are already 90% sold. Patients who pay high fees aren't stupid -- they're value driven.

I think your fees (your original fees) are totally reasonable. I know people in the Midwest who charge that amount and more. Your key task is to manage your anxiety, challenge your assumptions and BE PATIENT. Like someone else said, you have a job and income so you don't need to grow fast for any external reason -- patience is your friend. Trust me, the patience and work you put in will be totally worth it. Private practice is the best, especially when you aren't working with insurance and have total autonomy over your schedule, your patients, and the kind of care you deliver.

I hope this helps and I wish you the best with your practice!

Good post thanks for the insights from someone actually doing it..I saw your website you are charging like 1k per hour sometimes..very impressive

 

[surfguy84]

Hey FI-Prexa, congrats on starting your practice!

I can tell from your original post that you already have avoided one of the most common mistakes people make, which is starting with a a pricey office/expensive software solutions/too much overhead. You're also on point that you don't need to incorporate right off the bat. So many people I talk to get really focused on coming up with a creative practice name and incorporating with that name on day one, whereas it often doesn't make sense financially to incorporate until your second year of practice, when you're probably making enough money to reap the tax benefits of incorporation and it's worth the extra expense to pay for incorporation and an accountant to do your now more complicated taxes.

I saw someone comment on the claims vs occurrence based insurance -- yes it's true that with claims-based insurance you may have to pay for a tail policy at some point (often you don't have to pay for the tail if you are retiring at a minimum age), but a tail policy isn't THAT expensive, whereas an occurrence policy is typically extremely expensive, and you may be paying it for decades. I and everyone I know in PP goes with a claims-based policy. I was even in the position where I had to stop my policy for a period of time because I was on medical leave, and my insurance (MIEC) worked with me and let me pause it without paying a tail and then reactivate it when I was better.

Just three quick comments before I get into the meat of my response. First, these days psychiatry in private practice has really moved to tele, or at least hybrid in person + tele. So many patients prefer it (especially the higher functioning ones who tend to see PP psychiatrists) that I would advise you to consider seeing patients for in person for the initial, but then offering the option of tele for follow ups. From a marketing perspective, you can also fill faster when you do this because you can pull from a larger geographic area for your patient panel, because patients don't have to worry about driving to see you for every appointment. This will also make it easier to specialize or niche down should you desire to in the future -- again because you can pull your patients from a larger geographic area. Second comment -- you may find once you start filling (which you will) that it's kind of tricky to try to squish your patients all in one day.

Third comment -- the way you describe doing your screening in Luminello seems overly cumbersome for the patient. I think the best way to pre-screen patients is to have patients fill out an online contact form (it's much easier to make sure your patients know your fees over email first, rather that end up on the phone with people for whom your fees are a nonstarter), and then get on a quick phone call to build rapport and communicate your value (it's a skill set that you will grow making sure these phone calls don't go on forever), and then schedule the patient from a phone call.

Okay, now on to the main point I wanted to make -- you are worrying about filling way to prematurely and you lowered your fees too soon. There are 4 basic psychological stages to building a PP that everyone goes through:

0-3 months: Crippling terror - "This won't work, I'll never fill, no one will pay my fees, I should give up, I should cut my fees in half."
3-6 months: Moderate anxiety - "Okay I got a few patients, but they're not ideal patients, I don't know how to set boundaries, can I fire patients? I'll never be able to manage this"
6-12 months: Early confidence - "Okay this is staring to work... I'm not full yet, but I see how I could eventually be successful"
12+ months: Cruising

For the first six months your main task is not listening to your internal voice of anxiety. The reason you don't have patients yet is because 1) it takes time, and 2) you should be doing more to market. Psychology Today is great (I think it's one of the cheapest, highest yield way to get patients), but you could be doing a lot more with networking and referrals. You talked to five therapists and don't have any patients yet? Talk to a hundred and then get back to me. You're also right that concierge MDs are probably better referral sources than therapists. Therapists don't typically have large patient panels, and they just won't have as many referrals to potentially send you. They obviously also won't send you referrals you can do therapy with, and being able to do therapy is one of the joys of private practice. You also will fill faster with a smaller patient panel if you do therapy along with med management -- it's just math, since you're seeing those patients more frequently and for longer appointments.

I actually think one of the highest yield referral sources is connecting with another psychiatrist who is older/more established (maybe like your mentor) who is FULL and needs somewhere to send their overflow. Don't just send them a template email -- send them the nicest email ever sent in the history of humanity and offer to bring them lunch to their office or pay for an hour of supervision and then ask them advice about practice building. Even if you don't ask directly they will want to help you and will start sending you patients.

Let me just speak to fees for a second -- I know people will say all sorts of rules about looking at your competition/the market rate when deciding your fees, or that you shouldn't charge more than someone more experienced, or that you can't charge XYZ in the Midwest or whatever, but none of that is true. The difference between a psychiatrist who charges $300/hr and $1000/hr (or whatever amount) ISN'T CLINICAL SKILL. It's positioning and marketing. At a certain point we're all clinically "good enough." I know people may criticize that marketing is a dirty word, but marketing is just COMMUNICATING. How well do you speak to the internal fears and problems of your target market, and how well do you communicate that you will solve their problems? Your website should be the main place where you are communicating your value for potential patients, so that by the time they are calling you they are already 90% sold. Patients who pay high fees aren't stupid -- they're value driven.

I think your fees (your original fees) are totally reasonable. I know people in the Midwest who charge that amount and more. Your key task is to manage your anxiety, challenge your assumptions and BE PATIENT. Like someone else said, you have a job and income so you don't need to grow fast for any external reason -- patience is your friend. Trust me, the patience and work you put in will be totally worth it. Private practice is the best, especially when you aren't working with insurance and have total autonomy over your schedule, your patients, and the kind of care you deliver.

I hope this helps and I wish you the best with your practice!

Always enjoy seeing your posts around here.

 

[FI-Prexa]

You could try ZocDoc for advertising too. I'm not sure about their fees to be listed as a healthcare provider.

Thanks for posting your journey and being transparent. I look forward to your updates!

Thanks for the encouragement! I found the previous private practice threads super helpful, so wanted to pay it forward!

 

[FI-Prexa]

Hey FI-Prexa, congrats on starting your practice!

I can tell from your original post that you already have avoided one of the most common mistakes people make, which is starting with a a pricey office/expensive software solutions/too much overhead. You're also on point that you don't need to incorporate right off the bat. So many people I talk to get really focused on coming up with a creative practice name and incorporating with that name on day one, whereas it often doesn't make sense financially to incorporate until your second year of practice, when you're probably making enough money to reap the tax benefits of incorporation and it's worth the extra expense to pay for incorporation and an accountant to do your now more complicated taxes.

I saw someone comment on the claims vs occurrence based insurance -- yes it's true that with claims-based insurance you may have to pay for a tail policy at some point (often you don't have to pay for the tail if you are retiring at a minimum age), but a tail policy isn't THAT expensive, whereas an occurrence policy is typically extremely expensive, and you may be paying it for decades. I and everyone I know in PP goes with a claims-based policy. I was even in the position where I had to stop my policy for a period of time because I was on medical leave, and my insurance (MIEC) worked with me and let me pause it without paying a tail and then reactivate it when I was better.

Just three quick comments before I get into the meat of my response. First, these days psychiatry in private practice has really moved to tele, or at least hybrid in person + tele. So many patients prefer it (especially the higher functioning ones who tend to see PP psychiatrists) that I would advise you to consider seeing patients for in person for the initial, but then offering the option of tele for follow ups. From a marketing perspective, you can also fill faster when you do this because you can pull from a larger geographic area for your patient panel, because patients don't have to worry about driving to see you for every appointment. This will also make it easier to specialize or niche down should you desire to in the future -- again because you can pull your patients from a larger geographic area. Second comment -- you may find once you start filling (which you will) that it's kind of tricky to try to squish your patients all in one day.

Third comment -- the way you describe doing your screening in Luminello seems overly cumbersome for the patient. I think the best way to pre-screen patients is to have patients fill out an online contact form (it's much easier to make sure your patients know your fees over email first, rather that end up on the phone with people for whom your fees are a nonstarter), and then get on a quick phone call to build rapport and communicate your value (it's a skill set that you will grow making sure these phone calls don't go on forever), and then schedule the patient from a phone call.

Okay, now on to the main point I wanted to make -- you are worrying about filling way to prematurely and you lowered your fees too soon. There are 4 basic psychological stages to building a PP that everyone goes through:

0-3 months: Crippling terror - "This won't work, I'll never fill, no one will pay my fees, I should give up, I should cut my fees in half."
3-6 months: Moderate anxiety - "Okay I got a few patients, but they're not ideal patients, I don't know how to set boundaries, can I fire patients? I'll never be able to manage this"
6-12 months: Early confidence - "Okay this is staring to work... I'm not full yet, but I see how I could eventually be successful"
12+ months: Cruising

For the first six months your main task is not listening to your internal voice of anxiety. The reason you don't have patients yet is because 1) it takes time, and 2) you should be doing more to market. Psychology Today is great (I think it's one of the cheapest, highest yield way to get patients), but you could be doing a lot more with networking and referrals. You talked to five therapists and don't have any patients yet? Talk to a hundred and then get back to me. You're also right that concierge MDs are probably better referral sources than therapists. Therapists don't typically have large patient panels, and they just won't have as many referrals to potentially send you. They obviously also won't send you referrals you can do therapy with, and being able to do therapy is one of the joys of private practice. You also will fill faster with a smaller patient panel if you do therapy along with med management -- it's just math, since you're seeing those patients more frequently and for longer appointments.

I actually think one of the highest yield referral sources is connecting with another psychiatrist who is older/more established (maybe like your mentor) who is FULL and needs somewhere to send their overflow. Don't just send them a template email -- send them the nicest email ever sent in the history of humanity and offer to bring them lunch to their office or pay for an hour of supervision and then ask them advice about practice building. Even if you don't ask directly they will want to help you and will start sending you patients.

Let me just speak to fees for a second -- I know people will say all sorts of rules about looking at your competition/the market rate when deciding your fees, or that you shouldn't charge more than someone more experienced, or that you can't charge XYZ in the Midwest or whatever, but none of that is true. The difference between a psychiatrist who charges $300/hr and $1000/hr (or whatever amount) ISN'T CLINICAL SKILL. It's positioning and marketing. At a certain point we're all clinically "good enough." I know people may criticize that marketing is a dirty word, but marketing is just COMMUNICATING. How well do you speak to the internal fears and problems of your target market, and how well do you communicate that you will solve their problems? Your website should be the main place where you are communicating your value for potential patients, so that by the time they are calling you they are already 90% sold. Patients who pay high fees aren't stupid -- they're value driven.

I think your fees (your original fees) are totally reasonable. I know people in the Midwest who charge that amount and more. Your key task is to manage your anxiety, challenge your assumptions and BE PATIENT. Like someone else said, you have a job and income so you don't need to grow fast for any external reason -- patience is your friend. Trust me, the patience and work you put in will be totally worth it. Private practice is the best, especially when you aren't working with insurance and have total autonomy over your schedule, your patients, and the kind of care you deliver.

I hope this helps and I wish you the best with your practice!

This is super helpful, thank you! Just have to keep hustling.

- I updated my advertising to reflect an alternative way to contact me and pre-screen rather than Luminello if that is too cumbersome for them.

- Switched back my initial consultation rate, just going to trust the process and let it ride for right now.

- I do plan on offering telehealth and definitely am advertising as such!

- I have tapped into 2 senior psychiatrists for guidance/referrals. We will see if those materialize.

- I'm going to start mass emailing therapists/PCPs with offer to meet in person if interested.

Definitely open to other suggestions, those were very helpful!

 

[forchinet121]

This is super helpful, thank you! Just have to keep hustling.

- I updated my advertising to reflect an alternative way to contact me and pre-screen rather than Luminello if that is too cumbersome for them.

- Switched back my initial consultation rate, just going to trust the process and let it ride for right now.

- I do plan on offering telehealth and definitely am advertising as such!

- I have tapped into 2 senior psychiatrists for guidance/referrals. We will see if those materialize.

- I'm going to start mass emailing therapists/PCPs with offer to meet in person if interested.

Definitely open to other suggestions, those were very helpful!

Has insurance told you what they’re paying for 99214 and 90833?

 

[FI-Prexa]

Has insurance told you what they’re paying for 99214 and 90833?

I don't plan on taking insurance. I will provide a summary of services for patients to use to get some out-of-network reimbursement.