Patient Load For Private Practice

[VixRap]

How many patients could I expect a day?

I am hoping around 24.

Financially, that would be roughly $2,400 each day. Working 5 days a week for 8 hours while taking no off weeks, that's $720,000 on the year.

Can any psychiatrists vouch for this business model?

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[nitemagi]

Go to medical school first. Then you can decide if 24 patients a day with no days off is sustainable.

Here's a hint.

It's not. IMHO.

 

[VixRap]

Go to medical school first. Then you can decide if 24 patients a day with no days off is sustainable.

Here's a hint.

It's not.

Why?

 

[VixRap]

14 per day at $150 per meeting for 22 days per month = $540,000

Not bad.

Seems very feasible, no?

 

[VixRap]

Nice edit to make you sound less prick-ish.

Haha. It's all good.

 

[whopper]

Insurance pays on the order of about $75 per patient.

 

[OldPsychDoc]

Go to medical school first. Then you can decide if 24 patients a day with no days off is sustainable.

Here's a hint.

It's not. IMHO.

I thought he was being kind of wimpy actually. No reason you can't figure out everything going on with a patient in 10 minutes. He should plan on doubling his production and clearing a cool million at least! He could even take a couple of weeks of vacation now and then!

 

[VixRap]

Insurance pays on the order of about $75 per patient.

And the patient pays the rest, correct?

 

[OldPsychDoc]

And the patient pays the rest, correct?

They're so cute when they're young...

 

[F0nzie]

. He should plan on doubling his production and clearing a cool million at least!

[YOUTUBE]yowBTaf1uSA[/YOUTUBE]

 

[ghost dog]

And the patient pays the rest, correct?

Future dermatologist / pimple popper MD < troll .

They don't save any lives , right Jerry?

I forgot skin cancer !!

 

[whopper]

No reason you can't figure out everything going on with a patient in 10 minutes

You could use the old-magic eight ball, some D&D polyhedral dice, or just wing it for a diagnosis. Then after that, use the same method to determine a treatment. You wouldn't be much worse than the people giving out Ativan for everything.

 

[heyjack70]

My one piece of advice to aspiring psychiatrists is this: Get used to the taste of Top Ramen. And not the brand name Top Ramen, either.

 

[pingouin]

My one piece of advice to aspiring psychiatrists is this: Get used to the taste of Top Ramen. And not the brand name Top Ramen, either.

Excellent advice.

I saw Maruchan Ramen Noodles at the grocery store tonight for 8/$1. What a deal!!!!!

 

[F0nzie]

You wouldn't be much worse than the people giving out Ativan for everything.

Just get one of these for prescribing Ativan. Be sure to swing the pendulum at the start of the session to save time.

 

[nitemagi]

My one piece of advice to aspiring psychiatrists is this: Get used to the taste of Top Ramen. And not the brand name Top Ramen, either.

That's right. There's no money in this field. Errr, at all. None. Um. We're all starving and miserable. Move it along. Nothing to see here.

 

[sunlioness]

Excellent ideas in this thread. You could also conduct group therapy via ouija board.

 

[F0nzie]

I still eat alot of Ramen. Not because it's cheap but because it's good.

 

[Chimed]

I still eat alot of Ramen. Not because it's cheap but because it's good.

It's a specialty in some restaurants:
http://www.ippudony.com/

 

[zenman]

I thought he was being kind of wimpy actually. No reason you can't figure out everything going on with a patient in 10 minutes. He should plan on doubling his production and clearing a cool million at least! He could even take a couple of weeks of vacation now and then!

Might need 11 minutes for that patient with BPD, ADHD, PTSD, Bipolar DO....

 

[digitlnoize]

My one piece of advice to aspiring psychiatrists is this: Get used to the taste of Top Ramen. And not the brand name Top Ramen, either.

This totally made me lol. That deserves a roflcopter. Go Meta-Ramen!



I was actually going to advise the OP to utilize tele-psychiatry and pre-recorded video files of themselves nodding and saying "mmm hmm" a lot. Then at the end you can say, "I think I know what's wrong...you need Ativan." Then there is no limit to how much you can make!

 

[nitemagi]

This totally made me lol. That deserves a roflcopter. Go Meta-Ramen!



I was actually going to advise the OP to utilize tele-psychiatry and pre-recorded video files of themselves nodding and saying "mmm hmm" a lot. Then at the end you can say, "I think I know what's wrong...you need Ativan." Then there is no limit to how much you can make!

The OP clearly thinks like George Lucas.

http://www.youtube.com/watch?NR=1&v=ly_djozCksg

 

[ghost dog]

The OP clearly thinks like George Lucas.

http://www.youtube.com/watch?NR=1&v=ly_djozCksg

But does he have a CSA approved hair helmet?

I think this is the real question that needs to be addressed here.

 

[WhoisJohnGalt]

And the patient pays the rest, correct?

I think this is the best post I've ever seen on SDN.

 

[VixRap]

They're so cute when they're young...

$150 per 15 minute visit is actually quite cheap when talking CASH ONLY.

I was correct.

Psych is a money-making machine if ya know what you're doing.

FTR, I am a psych PATIENT. 10-15 minute visits are Max. Just medicine check-ups. Once a month. My doc is making bank.

 

[F0nzie]

Psych is a money-making machine if ya know what you're doing.

This is what I think of when you say "money-making machine":

 

[Starlightembers]

$150 per 15 minute visit is actually quite cheap when talking CASH ONLY.

I was correct.

Psych is a money-making machine if ya know what you're doing.

FTR, I am a psych PATIENT. 10-15 minute visits are Max. Just medicine check-ups. Once a month. My doc is making bank.

Are you OK with that, though? As another premedical psych patient, I never would have gotten to where I am now if I only say my psychiatrist once a month for 15 minutes (heck, I'm not even on medication anymore -- I was able to wean off of it after 1 year+ because so much progress was made via psychotherapy). I doubt I would have even been able to get to a point where I felt comfortable talking to him, never mind anything else. Maybe I'm a rarity in that way (I have a trauma background, which likely complicated it); but, as a patient, I really abhor the 15 minute medication check and specifically sought out a doctor who did therapy as well pharmaceuticals. I assume I can't be the only one who responds best to the combination.

And sorry to all the med students, residents and attendings for popping in...hope you all don't mind. I'll go back to just reading now.

 

[VixRap]

Are you OK with that, though? As another premedical psych patient, I never would have gotten to where I am now if I only say my psychiatrist once a month for 15 minutes (heck, I'm not even on medication anymore -- I was able to wean off of it after 1 year+ because so much progress was made via psychotherapy). I doubt I would have even been able to get to a point where I felt comfortable talking to him, never mind anything else. Maybe I'm a rarity in that way (I have a trauma background, which likely complicated it); but, as a patient, I really abhor the 15 minute medication check and specifically sought out a doctor who did therapy as well pharmaceuticals. I assume I can't be the only one who responds best to the combination.

And sorry to all the med students, residents and attendings for popping in...hope you all don't mind. I'll go back to just reading now.

Doesn't bother me a bit. My psychologist is the guy I talk with most. Psychiatrist just checks on my meds.

 

[digitlnoize]

$150 per 15 minute visit is actually quite cheap when talking CASH ONLY.

No way. Really? I've never seen someone charging THAT much. I've googled psych fee schedules and seen many private practice offices cash fees, and most seem to fall in the $75-100 per 15 min range...give or take. ~$300 an hour seems to be about the max.

Who is getting away with charging >$150?!? How much does your guy charge?

I think we're going to find ourselves in a bit of an ethical dilemma over the next decade or so. As the demand for psychiatrists continues to rise (as psychiatrists retire, few new ones are being made, etc), it's going to get easier and easier to buck the system and charge cash...and we'll likely to be able to charge whatever we want due to the drastic shortage, which is already very bad in some areas.

The question is: What should we charge? Is it right to charge the maximum the market will bear? Ordinarily, my right-wing self tends to argue "yes," but given the financial situation of our patients due to their illness, I am more willing to say that we have an ethical duty to charge a "reasonable" fee.

At this point, I think that $50-100 for a 15 minute med management appointment is acceptable price. $300 for 15 minutes? Now that starts to get abusive. To me.

Somewhere, I think there's a happy medium between the lifestyle we want and what we should ethically be charging patients. If we cross the boundary though, we could easily be vilified as a profession, and I think we'll have to tread carefully in the future to avoid that.

 

[F0nzie]

I am more willing to say that we have an ethical duty to charge a "reasonable" fee.

At this point, I think that $50-100 for a 15 minute med management appointment is acceptable price. $300 for 15 minutes? Now that starts to get abusive. To me.

I don't think you need to get ethics involved here. You can charge whatever you want- doesn't mean anybody will pay you for it. If you have the reputation to charge more and patients are willing to it's because you worked hard to get that recognition. I can see an unethical psychiatrist who gives out alot of benzos and stimulants gaining popularity- that would be unethical to me. Somehow we have ingrained that making money for our services is unethical, yet we practice medicine in a model that pays more for procedures and not so much for cognitive treatments.

Supply and demand. If things ever get to the point that the average psychiatrist can charge $300 for 15 minutes you will have an influx of medical students shifting to psychiatry and don't forget more psych NP's getting their hands in the candy jar. Don't worry, psych NP's bill at the same rate as psychiatrists and they can do EVERYTHING we do except maybe forensic psychiatry. Point I'm trying to make is there are alot of factors that will keep our salary in check- and making more money is probably the least of our concerns.

 

[toothless rufus]

...and don't forget more psych NP's getting their hands in the candy jar. Don't worry, psych NP's bill at the same rate as psychiatrists and they can do EVERYTHING we do except maybe forensic psychiatry.

Is this true?! What about PAs? The same rate as PHYSICIANS? So they make as much as docs with 4 years of medical school and 4 years of residency?! That's ridiculous. And unfair. And undeserved.

 

[Shufflin]

Can psych NPs and PAs manage medications and write prescriptions? I would be very surprised, along with most medical students in the world, to learn this to be true. I'm guessing no.

 

[nitemagi]

Is this true?! What about PAs? The same rate as PHYSICIANS? So they make as much as docs with 4 years of medical school and 4 years of residency?! That's ridiculous. And unfair. And undeserved.

Like most alarmist statements, there's some truth to this. They can bill insurance, not quite at the same rate (though I believe it depends on state). Some states allow them to practice unsupervised, but that's less common. Where the real separation of the curve comes out is in fees for cash practice, where MD's are always able to charge more in their practice. Furthermore, salaried positions are also a huge difference (inpatient setting, for example).

 

[sunlioness]

Can psych NPs and PAs manage medications and write prescriptions? I would be very surprised, along with most medical students in the world, to learn this to be true. I'm guessing no.

They can. Whether they can do so independently or require direct supervision by a physician varies by state. I know in PA and in IL, they must be supervised.

 

[digitlnoize]

Is this true?! What about PAs? The same rate as PHYSICIANS? So they make as much as docs with 4 years of medical school and 4 years of residency?! That's ridiculous. And unfair. And undeserved.

Degree creep is here to stay, I think. For us, I think the good news is that the psych shortage is SO bad that even with the NPs and PAs there still won't be enough providers to go around...

Psych is a very "elderly" field. Over 55% of practicing psychiatrists are >55yo.

Psych is also becoming a female dominated field. The majority of new psychiatrists being produced are women, especially in C&A. I love and respect my female colleagues and all, girl power, so no one take what I'm about to say the wrong way, but statistically speaking female doctors tend to work less hours than their male counterparts. Many work part time, or have kids and take time off for that, or what have you. I think you could argue that they might make up for some of that slight hour/week decrease by having a longer career (due to longer life span), but I don't think that's been born out in the research yet. Again, I'm definitely NOT saying women doctors are slackers or anything of the sort, and it's not a HUGE difference (-25% TOPS, according to the studies I've seen), but there does seem to be a difference.

Anyways, the point is, there is a bad, bad shortage, and we are probably the field that should be concerned the least about mid-level practice rights. Who needs to worry? IMO, Anesthesia, EM, and Derm.

 

[LIDO]

Fields such as anesthesiology had the same mentality of not worrying about mid-levels back in the 90s....look where that got them. You should always be concerned about the longevity/protection of your field despite whatever the current status may be. Strong support now prevents mid-level issues in the future.

 

[sunlioness]

Due the critical shortage of mental health providers currently and the barriers to access nationwide because of this shortage, I don't think I can in good conscience advocate for something that is going to deprive patients of needed care unless I thought that the care being provided was harmful or substandard in some way. I don't think in the case of NPs being supervised by physicians that it is.

 

[Sneezing]

1/2 the states in the union they don't have to be supervised.

 

[michaelrack]

At this point, I think that $50-100 for a 15 minute med management appointment is acceptable price. .

"They're so cute when they're young"

You are not going to collect all you charge, even in a cash only practice-
There is plenty of uncompensated time, still.
Overhead is higher than you imagine.
there will be no-shows.
$50 is a bit low.

 

[whopper]

My own experience from PP is that plenty of people call the office and ask questions or other things such as prior authorizations, signatures on lab forms, etc. The total accumulated time for this takes up about 15 minutes to 1 hour a day and I do not get paid for that.

And yes I am doing things such as having staff members screen calls. Some patients are just high-maintenance. Remember, as a demographic, people with psychiatric problems have issues. I have one patient, for example, and she always loses scripts...always. Anytime I see her, I anticipate about 10 minutes that I can't bill having to fix the messes she later makes for herself by forgetting to do labs, losing scripts, etc.

(No, she is not losing a script to an abusable med. If that were the case, I'd just tell her I wouldn't write her another one).

Now that's just one patient. When you have a few hundred patients, a few patients do this, and they waste your time.

 

[digitlnoize]

"They're so cute when they're young"

You are not going to collect all you charge, even in a cash only practice-
There is plenty of uncompensated time, still.
Overhead is higher than you imagine.
there will be no-shows.
$50 is a bit low.

I agree that $50 was on the low end (I've never heard of someone actually charging/getting that), but I was being a bit generous with my numbers.

Still, $50 for a 15 minute visit x 3 visits/hour (with one 15 minute period per hour for other issues x 7 hours a day (1 hour for lunch, 1 extra hour for other issues) x 5 days a week x 48 weeks a year (4 weeks vacation) - 40% overhead+uncollected money (which is high, I think, but whatever) =

$151,200 per year (before taxes). Agree that it's on the low end, but that's at a meager $50, a slack day, lots of time built in for other issues that come up, and higher overhead than has been sited on this board previously...and still a fairly comfortable salary (although I agree that we'd all like more).

Again, I'll say that the shortage of psychiatrists can only be expected to worsen from this point forward, which only strengthens our position to charge whatever the market will bear.

The issue is one that I continually faced back in my music days. To paraphrase Douglas Adams, Music stores cater to the one segment of the population that, by definition, has no money...penniless musicians. Psychiatrists are much the same. Our patients tend to "Fail Downward" due to their illnesses and a large portion of them are not in a position to be able to afford >$100/hr+ care. So, at what price point are we failing to serve our patients (and society)...I'm not sure...

Now, I will defer to those of you WITH morals to answer this question. I myself plan on charging $300/hour if I can get away with it, and to hell with the rest of you. That Ferrari won't buy itself

One more thing: If you have a cash-only practice, why CAN'T you bill for those extra services (phone calls, etc)?

 

[nitemagi]

One more thing: If you have a cash-only practice, why CAN'T you bill for those extra services (phone calls, etc)?

You can bill for it. That doesn't mean they'll agree to pay it. I had one mentor that had a "retainer" system for especially wealthy clientele, often paid by families ahead of time. They'd chunk down 10k at a time and he'd just deduct from it based on how often he saw the pt. that month.

 

[digitlnoize]

You can bill for it. That doesn't mean they'll agree to pay it.

That's what I'm saying. If they don't agree to pay it, then why agree to see them? I have seen people charging for phone calls and things on their websites...

I think part of the problem is that no other doctors do it, so we can't either. Somewhere along the way physicians somehow got duped into working a lot for free. We do the insurance companies' paperwork for them, deal with their customers for them, make phone calls and do other leg work without reimbursement, and somehow we're *****holes if we charge for that stuff...

In the words of Rage Against the Machine: We gotta take the power back!

 

[F0nzie]

I can see how charging 10k upfront saves you from the hassle of writing invoices for "extra services", and not having to get collection agencies involved for non-paying patients. It also tailors to needy patients or patients with special circumstances. My personal stance on "concierge practice" is one of ambivalence due to the risks of expanding boundaries in a counter-therapeutic way. I'm still a resident and obviously don't have my own private practice or the independent experience, but it would be interesting to hear a concierge psychiatrist's view and personal experience on this issue.

If you plan to charge for "extra services", those services should be clearly listed in the patient-doctor/practice policy contract in a section under financial responsibility. You may even require a credit card on file to account for late cancellations and additional services. I don't seen anything ethically wrong with this type of policy as long as it's in writing and the patient signs for it.

 

[whopper]

I was thinking of maybe charging patients who ask me to talk to them over the phone. Not because I believe in phone interviews, I don't. Just that so many patients expect me to talk to them for an extended duration even when staff members and I tell them if that's what they want, they need to talk to me in the office.

 

[michaelrack]

$151,200 per year (before taxes). Agree that it's on the low end, but that's at a meager $50, a slack day, lots of time built in for other issues that come up, and higher overhead than has been sited on this board previously...and still a fairly comfortable salary (although I agree that we'd all like more).

QUOTE]

that's an ok salary, but not a high enough income, in my opinion, to justify the risk of opening up a small business (psychiatric practice). If you open up a practice and something goes wrong, you are still on the hook for rent, malpractice, etc. Plus benefits (your retirement, health ins, etc needs to come out of the 150k). If you are satisfied with a salary of 150k, there are plenty of nice, easy-going 35-40 hour state hosp/comm ment health center jobs out there.

 

[digitlnoize]

that's an ok salary, but not a high enough income, in my opinion, to justify the risk of opening up a small business (psychiatric practice). If you open up a practice and something goes wrong, you are still on the hook for rent, malpractice, etc. Plus benefits (your retirement, health ins, etc needs to come out of the 150k). If you are satisfied with a salary of 150k, there are plenty of nice, easy-going 35-40 hour state hosp/comm ment health center jobs out there.

I agree 100%, but I was being (I think) very pessimistic with my numbers. Real reimbursement is not $50/med management (that I know of) and real overhead is not 40%. Just trying to illustrate the absolute worst case scenario is not THAT bad.