Why has your outlook fizzled? Have you tried something that failed? I am going to start a PP soon..cash only...
The advantages of cash practice are always glorified ie. "decrease administrative costs", "spend more time with the patient", "increase revenue", "deliver quality care". Clearly these buzzwords proclaim everyone is a winner which is why everyone wants to do it. However, it isn't a surprise to me that rarely anybody does it. The biggest and most important question is:
where are you going to get these patients?
Since I do not have any real experience in starting up a cash practice and most of my knowledge is researched based and hypothetical, for all I know, patients will break down my office door like a stampede of suburban women at a gourmet cupcake shop. I can then set my own hours, work half as hard, and not have to deal with the politics and bureaucracy of organized medicine.
I believe that many factors are involved in starting up a successful cash practice and getting all the stars to align to meet your personal goals can be challenging. Here is some practical advice for those of you wanting to capitalize on this:
1. Location
-accessibility, parking, commute time
-number of practicing psychiatrists in the area ie. market saturation
-upper middle class to upper class median family income
-total population
-cultural (openness to mental health treatment and actively looking for it) NYC? LA?
2. Financial plan
-accounting, balance sheets, method of payment, payroll
-LLC,corp, partnership, group practice, or sole proprietor
3. Reducing overhead costs even further
-cheap and integrated EMR for e-rx, lab
-online scheduling
-google voice
-answering service
-online fax solutions
-web Design, PDF forms, online requests
-consider outsourcing your billing if you accept insurance
4. Referral sources/marketting
-building alliance with therapists, primary care physicians, schools (child psych)
-social media, internet (extremely low yield IMO)
-newspaper articles, email newsletters/fax
5. Uniqueness.
-after hours and weekends? (attractive but sets you up for liability)
-telephone? email? video conferencing (another malpractice trap without nursing supervision)
-on call availability? same day or next day appointments?
-added qualification? (academic, research, writing, tv, newspaper, other media)
-Your personality and professionalism (do people like you and will they refer you to others?). Establishment in the community.
Why do I think these factors are important? Because starting a cash practice is like being Jupiter's moon and hoping that an amateur star gazer will look through a telescope and notice you.
Additional uphill challenges on a Macro scale:
-most patients do not want to pay to see a doctor, especially if they are already paying to have insurance. If they do not have insurance then they can't afford to see you.
-most patients go through their insurance company first and tolerate the wait.
-the stigmatization of mental illness is more extreme in some parts of the country than others, reducing your demand as a concierge provider.
-big fish eat the small fish (group practice mergers, larger healthcare organizations, etc), further reducing demand in larger cities while shortages exist in rural areas where people cannot afford to pay out of pocket.
With all of this in mind, I do believe it is possible to have a successful cash private practice. The inner workings of the "machine" are highly complex and influenced by a lot of factors that are constantly changing. Tailoring your practice to meet your personal and financial goals will be by far the most difficult challenge you will face.
I shall find out in 2013 after I graduate from residency if this is a viable model and report back with my successes and shortcomings. I am currently in the process of setting everything up. If anything, it might just be nice to have a private practice on the side where I can at least meet overhead costs and claim some tax deductions.