I dont see the benefit in opening your own practice if youre paying for an office space, waiting for your panel to fill, just to make 400k in the end. Seems doable nowadays with employed positions alone. I guess autonomy is the only benefit.
money
In that case inpatient/corrections locums in the morning + PP clinic afternoon is probably the highest ceiling without spending years to build. You can cobble together 2-3 "full-time" positions and hit well over $500k fairly quickly. This will likely require flexibility and some sacrifices with work/life balance, but it's very doable.
For me it was less about just hitting certain numbers but how you get there and being able to maintain it easily. Most young guns just look at the raw numbers. I looked at never working nights, wknds, or holidays and having maximum autonomy and being hard to replace. PP and admin role like med director make a pretty solid combo with some longevity built in.
Nice thing is, if that happens you can just walk to the next place, or do locums. Demand for us is much higher than supply
Or if you're at a VA the annual DV screening/assessment. Plus the annual treatment plan update. And good luck if you have to do a CSRE for any positive Columbia and enter it into CPRS during your appointment. Can't count how many times during my outpatient year I had to stay late filling out completely unnecessary forms into the ancient EMR.
At least in PP you can choose to do things like phone screening for those CC's, putting info about it on your website, or saying "no" in a way that only reflects on that person's word of mouth about you vs. word of mouth about your organization with subsequent potential engagement with associated institutional complaint mechanisms. Costs and benefits to those actions, of course.
lol
Good question/point, no one in my chain of command is going to give me crap about saying "no." Which I do on a regular basis. But I am aware that when I say "no" it reflects on the organization ("Kaiser sucks") as a whole in a way that I do care about a little and often generates extra work for the system (transfer intake appointment, complaints, etc.)
I would argue almost as important if not more important decision to make if this is the case is actually: 1) don't buy a house and rent a reasonable priced living space. 2) don't buy a new or luxury car. 3) don't accept a job that'll limit your capability to work elsewhere if you can.
My dentist has disposable slippers for each patient when they arrive if they want it, paraffin hand wax, a massage chair, TV on the ceiling with airpod noise cancelling headphones, gives me a lavender face towel after. It's really a luxury dental experience.
I mean it wasn't a vigorous massage chair.
Having grown up in the country, I like a lot of this. I can't imagine the liability of having a combination rifle range and outpatient psychiatry clinic though.
No. I think it’s a misconception that the affluent wants snake oil. Snake oil is the opposite of luxury.
Working with the sicker patients and charging for it is what I do and a lot of what you say resonates with my own experience. Part of why most outpatient therapists don’t want to work with the sicker patients is because the insurance based system isn’t conducive to the type of treatment support that these patients need. I see it from the other perspective where psychiatrists aren’t willing to see my patients. Mist psychiatrists and PMHNPs that I meet seem to think they should have a huge panel with monthly appointments until that can be stretched into longer intervals. I don’t think this is an artifact of thinking about treatment as much as that is what systems create and people think that is how it should be.
I do see many entitled patients in my PP and I get consultation on how to set boundaries. I’d much rather deal with “give me Adderall because I lack focus and productivity” since I’m pretty good at trying to assess for the reason why they want Adderall and can suggest behavioral interventions or med recs for comorbidties if they don’t meet criteria. I try to whiff out personality disorders and those who won’t be collaborative in the phone screen, which I always do before I take them on as patients. It’s uncompensated monetarily but really prevents me from more headaches down the road. I probably get one intake every few months that’s entitled beyond reason and usually I discharge them from my PP or they don’t stick around since they don’t like being told no so often.
I really doubt anyone who has spent years working with medicaid and years working with the top 1% SES would have the conclusion that the top 1% are less reasonable or more substance seeking. I do love working with the Medicaid population but ho boy there were some serious zingers sprinkled in there in a way you just do not find with the wealthy. Had a dad repeatedly calling his 8 yo son the N word (they were both Caucasian), I thought I misheard him the first time and when I heard it a second time and redirected him, he screamed so loud they could hear it in a neighboring surgical center that was through two huge concrete walls. Got about 50 different slurs hurled my way as security escorted him from the premises...
I have a lot more but that one stands out for the sheer intensity and absurdity of the situation. To come into a child clinic and expect to rain severe obscenities at your own child and then at the physician for calling you out on those obscenities to the point of bringing in staff/security from several neighboring wings of the office is not an average day before lunch for employed psychiatrists. I trained in fellowship with very low SES patients making up the bulk of our patients and had only a few situations even close to that through 2 years.
That's true. I'm solo PP and don't have to deal with random patients being put on my schedule that I have no control over. I screen very carefully to select out personality disorders. I also don't take any insurance which probably helps. The autonomy is unparalleled.
Not if you do good combined treatment with substantial insight oriented focus (i.e. core belief restructuring, schema reformatting, confrontation of subconscious, whatever theoretical orientation you have).
