Private practice - any regrets?

[neuropsych54321]

For those who made the shift to private practice from AMC/hospital settings, any regrets?

I have been deliberating this move for a couple of years. Many things excite me about moving into PP but I have been too scared to make the leap from the known into the unknown. I am worried about regret of leaving a relatively stable (but increasingly unhappy) situation, and what I would do PP ends up being a poor fit.

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[WisNeuro]

No regrets. I enjoy the very large bump in income, and the schedule flexibility helps out immensely with planning around young children's schedules. If it's a poor fit, you can always go back to working for a hospital system. I still see pretty regular job postings in my area.

 

[Therapist4Chnge]

Only that I wish I did it sooner. Doing it during the middle of the pandemic complicated things, but ultimately the flexibility and increased economic opportunity far outweigh the bumps in the road.

 

[Sanman]

While I have not worked in my own PP, I have worked in group PP as a contractor and employee and now in a hospital system. IMO, happiness in PP has more to do with your personal financial situation and general life situation. If you have partner that brings in a steady income or are financially comfortable otherwise and natural ebbs and flows of business do not bother you, it will give you significantly more flexibility.

If things like access to good health insurance and vacation/sick days are important than it may not be as good of a fit. As someone using the parental leave benefit at my job this year, I would be crying in PP right now. However, it will likely be a better fit for my life than a hospital gig in a couple of years as my kid gets older.

 

[WisNeuro]

While I have not worked in my own PP, I have worked in group PP as a contractor and employee and now in a hospital system. IMO, happiness in PP has more to do with your personal financial situation and general life situation. If you have partner that brings in a steady income or are financially comfortable otherwise and natural ebbs and flows of business do not bother you, it will give you significantly more flexibility.

If things like access to good health insurance and vacation/sick days are important than it may not be as good of a fit. As someone using the parental leave benefit at my job this year, I would be crying in PP right now. However, it will likely be a better fit for my life than a hospital gig in a couple of years as my kid gets older.

This is technically available in PP. Particularly if you are making significantly more money on a per hour basis. For example, I could take the rest of the year off at this point and I will still net more than I did working in my old hospital job. So, no, you are not technically getting PTO, in the technical sense, but does that really matter?

 

[Sanman]

This is technically available in PP. Particularly if you are making significantly more money on a per hour basis. For example, I could take the rest of the year off at this point and I will still net more than I did working in my old hospital job. So, no, you are not technically getting PTO, in the technical sense, but does that really matter?

That depends on how much you make. Your work is very different from the former hospital job.

 

[WisNeuro]

That depends on how much you make. Your work is very different from the former hospital job.

Half of it is, but even that clinical half nets me a good deal more than the hospital per hour reimbursement.

 

[PsyDr]

1) No regrets
2) You should assume that it is not stable. Due to a combination of how insurance pays, and how referrals work, you could make $40k+ one month, followed by a $1k month. There is no consistent volume of patients, nor consistent work volume expectation. Instead there are huge waves of referrals, sprinkled with brief periods of time where there is no work. If you manage cashflow and workflow, it's relatively easy to prioritize. Oh, and those slow times? They never come when you want them to. I do know a few specialized psychologists that plan their schedule far in advance. They might be limiting their income, in favor of lower stress.
3) Once you have your workflow managed, you get to see a direct correlation between your efforts and your rewards.

 

[summerbabe]

I don’t think there’s one size fits all answer but you’re unhappy now, so it’s definitely worth considering (or other institutional jobs).

I’m happy with my fully telehealth VA therapy gig. I typically have 4 patient slots a day (often with 1 no-show or cancellation) and spend the rest of my workday between admin tasks, meetings, and a good chunk of household chores/non-work stuff. And I use some evening times a few times a week (while watching TV) for remaining notes or work tasks because I prefer spacing my work out.

Could I squeeze out more income in PP? Probably. Or have more flexibility and autonomy? Absolutely.

But the lifestyle, routine, and comp/benefits work well for me at this stage in my life.

If you make the jump to PP and it’s not a good fit, I’m sure you’d be able to jump back into institutional neuropsych jobs (and hopefully at a better spot).

 

[WisNeuro]

1) No regrets
2) You should assume that it is not stable. Due to a combination of how insurance pays, and how referrals work, you could make $40k+ one month, followed by a $1k month. There is no consistent volume of patients, nor consistent work volume expectation. Instead there are huge waves of referrals, sprinkled with brief periods of time where there is no work. If you manage cashflow and workflow, it's relatively easy to prioritize. Oh, and those slow times? They never come when you want them to. I do know a few specialized psychologists that plan their schedule far in advance. They might be limiting their income, in favor of lower stress.
3) Once you have your workflow managed, you get to see a direct correlation between your efforts and your rewards.

Definitely, though I've gotten better about scheduling as time goes on to avoid getting crazy busy weeks and looming deadlines. But, every now and then someone drops like 4k pages of records for an upcoming IME that I didn't plan for.

 

[smalltownpsych]

No regrets. Made the jump just over a year ago. I also enjoy running a business and marketing and am pretty good at sales so it gives me a chance to wear a few extra hats and not just crank out the clinical work. I find that a variety of tasks and challenges, although my main love and skills are in the clinical realm, helps keep it fresh for me. I also am excited that I have the potential to make some real money like a couple of the other posters here. Unlike others, I haven’t hit a slow spot but I also get about half my revenue from clients who pay a flat rate so that helps keep it stable. The main dip in revenue is when I take time off so if I can get some of the more stable revenue streams up then that will help with that part. That’s the goal for year two.

 

[AcronymAllergy]

No regrets here, either. Although I agree that a lot of that will probably depend on your personal situation, personal characteristics, and what you do/like to do. As PsyDr mentioned, PP is inherently less stable and predictable, and is less of a known quantity, than a standard hospital/medical center job. There are pros and cons to that, but it definitely takes some planning ahead. There's more work required on the administrative/business management side of things, but the trade-off is (usually) better reimbursement and more flexibility. Being able to actually write stuff off is also pretty fun. It can easily become isolating, especially if going it fully on your own, but there are ways of reducing/preventing that. And with some practice areas/interests, PP may be less feasible, unless you're open to branching out and also doing things that will pay the bills.

I'd say the main things I miss: being able to walk down the hall and talk to colleagues, library access, having numerous referral resources at the same facility, and easy access to medical records. But I would trade pretty much all that just for not having to submit VA leave requests. And some of those things are potentially replaceable, such as if I looked into getting credentialed with a local hospital.

And I'd agree with WisNeuro--in general, salaried hospital positions don't seem to be in short supply, especially in VA at the moment. Although that's not to say you'd be able to quickly find a position in your area, doing what you want, and making as much or more as you are now (but that's the case with any job change).

 

[taylortaylor164]

I don’t think there’s one size fits all answer but you’re unhappy now, so it’s definitely worth considering (or other institutional jobs).

I’m happy with my fully telehealth VA therapy gig. I typically have 4 patient slots a day (often with 1 no-show or cancellation) and spend the rest of my workday between admin tasks, meetings, and a good chunk of household chores/non-work stuff. And I use some evening times a few times a week (while watching TV) for remaining notes or work tasks because I prefer spacing my work out.

Could I squeeze out more income in PP? Probably. Or have more flexibility and autonomy? Absolutely.

But the lifestyle, routine, and comp/benefits work well for me at this stage in my life.

If you make the jump to PP and it’s not a good fit, I’m sure you’d be able to jump back into institutional neuropsych jobs (and hopefully at a better spot).

I am curious what clinic you are working in? That sounds like a really sweet deal, especially the telehealth aspect!

 

[Gepetto]

In addition to all of the above: it depends on your plan. Kids? Adults ? Private pay? Insurance? Forensic work?

I know several neuropsychs leaving private practice because they weren’t interested in doing IMEs or forensic work. It was hard to be profitable with an insurance based practice and not supplement income. I’ve heard this from people in 20+ years of private practice. If you see kids - you can do private pay and make a living I think. Parents will pay for kids. But it’s a much harder sell to convince someone with insurance to pay out of pocket for something like a dementia eval.

Maybe this is specific to the metro area I live in , but everyone I’ve spoken to so far about PP has made discouraging comments about difficulty making it profitable … not able to stop taking forensic eval bc they need the income but don’t enjoy them .. etc.

 

[WisNeuro]

In addition to all of the above: it depends on your plan. Kids? Adults ? Private pay? Insurance? Forensic work?

I know several neuropsychs leaving private practice because they weren’t interested in doing IMEs or forensic work. It was hard to be profitable with an insurance based practice and not supplement income. I’ve heard this from people in 20+ years of private practice. If you see kids - you can do private pay and make a living I think. Parents will pay for kids. But it’s a much harder sell to convince someone with insurance to pay out of pocket for something like a dementia eval.

Maybe this is specific to the metro area I live in , but everyone I’ve spoken to so far about PP has made discouraging comments about difficulty making it profitable … not able to stop taking forensic eval bc they need the income but don’t enjoy them .. etc.

In all but the highest CoL, I call BS. If I saw only Medicare patients at the rate that I saw patients in my hospital system based job, I'd still gross 20k more after accounting for benefit expenses (e.g., retirement, insurance). And that's doing all my own testing. If I even hired a part-time psychomterist for 15-20 hours a week, I'd destroy that number. Unless this is NY, SF, or similar, these people are simply bad at the business aspect.

 

[Gepetto]

In all but the highest CoL, I call BS. If I saw only Medicare patients at the rate that I saw patients in my hospital system based job, I'd still gross 20k more after accounting for benefit expenses (e.g., retirement, insurance). And that's doing all my own testing. If I even hired a part-time psychomterist for 15-20 hours a week, I'd destroy that number. Unless this is NY, SF, or similar, these people are simply bad at the business aspect.

I’m in a fairly high CoL area, but I think the issue for at least 2 of the folks I spoke to is they run group practices , so by the time they pay out the overhead and employees, they aren’t making what they want (i never got a specific number from them). What I’ve noticed out here is you have to be willing to take every insurance. Neurologists don’t want to have to think about who to send where - they will send you everyone if you’re INN, or no one if you’re only INN with a few panels.

 

[CheetahGirl]

Hi Folks (!) ~ not to hijack this thread but does anyone have opinions on up & coming telehealth agencies to kickstart one's PP, like ********** or ********? I don't have any well-formed opinions about them yet, only to say our large urban AMC is getting many patient referrals for our group or more specialized psychotherapies, and these patients are being followed by online therapists (where therapists & patients never met in person).

Of course, I noticed this new wave of private practice therapists post-pandemic and it's exponentially growing. Several agencies are actively trying to recruit their workforce via LinkedIn (even if you're not looking for another job). I was wondering if anyone has experience with one of them (please PM if you'd like to privately discuss) because the flexibility and potential ROI are enticing.

(I've also noticed and am somewhat fearful about the rise in improperly-vetted, non-evidence based, psychedelic-assisted psychotherapies offered by 'life coaches' but that's a separate beast to contend with in the future - and I suppose the safeguard in that realm is whether or not the provider is licensed in the State they are offering these therapies.)

I believe the main recruitment attraction for the telehealth agencies is legitimate licensed providers.

*Edit: It doesn't matter which company...there are plenty actively recruiting and each looks better than the next. 🤔💕

 

[AcronymAllergy]

Hi Folks (!) ~ not to hijack this thread but does anyone have opinions on up & coming telehealth agencies to kickstart one's PP, like BetterHelp or Octave? I don't have any well-formed opinions about them yet, only to say our large urban AMC is getting many patient referrals for our group or more specialized psychotherapies, and these patients are being followed by online therapists (where therapists & patients never met in person).

Of course, I noticed this new wave of private practice therapists post-pandemic and it's exponentially growing. Several agencies are actively trying to recruit their workforce via LinkedIn (even if you're not looking for another job). I was wondering if anyone has experience with one of them (please PM if you'd like to privately discuss) because the flexibility and potential ROI are enticing.

(I've also noticed and am somewhat fearful about the rise in improperly-vetted, non-evidence based, psychedelic-assisted psychotherapies offered by 'life coaches' but that's a separate beast to contend with in the future - and I suppose the safeguard in that realm is whether or not the provider is licensed in the State they are offering these therapies.)

I believe the main recruitment attraction for the telehealth agencies is legitimate licensed providers.

I don't really provide therapy presently, but my knee-jerk response is that if you offered telehealth services on your own and got on a few insurance panels, you'd earn more and have fewer stipulations to abide by. The main upside offered by the large teletherapy platforms, from what I can gather, is basically ease of use for the provider--it's essentially a "plug and play" setup. You show up, they get you patients, get you the platform, get you the EHR system, take the payment, schedule everything, etc. In exchange, they take a chunk of money.

I haven't worked via any of those platforms, so I can't say whether they seem worthwhile. But if you're able to search providers, you could see if there are lots of psychologists, or if psychologists are few and far between, which could be telling.

And yes, the number of questionably-trained "providers" offering mental health-adjacent services seems to have exploded a bit since the start of COVID-19. I think it also coincides with younger generation(s) being not just more accepting of MH services, but in some cases, of wanting to be in therapy and/or have a diagnosis for social reasons.

 

[WisNeuro]

I’m in a fairly high CoL area, but I think the issue for at least 2 of the folks I spoke to is they run group practices , so by the time they pay out the overhead and employees, they aren’t making what they want (i never got a specific number from them). What I’ve noticed out here is you have to be willing to take every insurance. Neurologists don’t want to have to think about who to send where - they will send you everyone if you’re INN, or no one if you’re only INN with a few panels.

Not my experience at all. I am only paneled with Medicare and two of the higher payors here and have zero problem getting the several neurologists I work with to only send me those patients. They don't care, as long as your work is good, their nurses take care of everything on the faxing/admin side anyway. They care more about not waiting 9+months to get an eval if they stay in their own system. This takes a fairly minimal amount of time networking on the front end.

Hi Folks (!) ~ not to hijack this thread but does anyone have opinions on up & coming telehealth agencies to kickstart one's PP, like BetterHelp or Octave? I don't have any well-formed opinions about them yet, only to say our large urban AMC is getting many patient referrals for our group or more specialized psychotherapies, and these patients are being followed by online therapists (where therapists & patients never met in person).

Of course, I noticed this new wave of private practice therapists post-pandemic and it's exponentially growing. Several agencies are actively trying to recruit their workforce via LinkedIn (even if you're not looking for another job). I was wondering if anyone has experience with one of them (please PM if you'd like to privately discuss) because the flexibility and potential ROI are enticing.

(I've also noticed and am somewhat fearful about the rise in improperly-vetted, non-evidence based, psychedelic-assisted psychotherapies offered by 'life coaches' but that's a separate beast to contend with in the future - and I suppose the safeguard in that realm is whether or not the provider is licensed in the State they are offering these therapies.)

I believe the main recruitment attraction for the telehealth agencies is legitimate licensed providers.

I haven't worked with these platforms, but know colleagues who have tried them out. The feedback from them was almost universally negative. Seems that the only people who stay on the services are midlevels or diploma millers.

 

[CheetahGirl]

I haven't worked with these platforms, but know colleagues who have tried them out. The feedback from them was almost universally negative. Seems that the only people who stay on the services are midlevels or diploma millers.

This was my fear that my future career reputation may be tarnished but I want more flexibility and I maintain a hybrid schedule now (sometimes more virtual versus in-person) so am entertaining branching out on my own.

I don't really provide therapy presently, but my knee-jerk response is that if you offered telehealth services on your own and got on a few insurance panels, you'd earn more and have fewer stipulations to abide by. The main upside offered by the large teletherapy platforms, from what I can gather, is basically ease of use for the provider--it's essentially a "plug and play" setup. You show up, they get you patients, get you the platform, get you the EHR system, take the payment, schedule everything, etc. In exchange, they take a chunk of money.

I haven't worked via any of those platforms, so I can't say whether they seem worthwhile. But if you're able to search providers, you could see if there are lots of psychologists, or if psychologists are few and far between, which could be telling.

And yes, the number of questionably-trained "providers" offering mental health-adjacent services seems to have exploded a bit since the start of COVID-19. I think it also coincides with younger generation(s) being not just more accepting of MH services, but in some cases, of wanting to be in therapy and/or have a diagnosis for social reasons.

This is my hope to sustain livelihood for the next few years. I often love my 40-50 hr/wk job but family demands consistently call so I'm now thinking of part-time hours until my youngest child is in college. Letting my assistant professorship will be difficult so I don't want to hinder future opportunities of returning to faculty positions if I do branch out to telehealth PP.

Thank you, @WisNeuro and @AcronymAllergy - your time is much appreciated.

 

[summerbabe]

Hi Folks (!) ~ not to hijack this thread but does anyone have opinions on up & coming telehealth agencies to kickstart one's PP, like BetterHelp or Octave? I don't have any well-formed opinions about them yet, only to say our large urban AMC is getting many patient referrals for our group or more specialized psychotherapies, and these patients are being followed by online therapists (where therapists & patients never met in person).

Of course, I noticed this new wave of private practice therapists post-pandemic and it's exponentially growing. Several agencies are actively trying to recruit their workforce via LinkedIn (even if you're not looking for another job). I was wondering if anyone has experience with one of them (please PM if you'd like to privately discuss) because the flexibility and potential ROI are enticing.

(I've also noticed and am somewhat fearful about the rise in improperly-vetted, non-evidence based, psychedelic-assisted psychotherapies offered by 'life coaches' but that's a separate beast to contend with in the future - and I suppose the safeguard in that realm is whether or not the provider is licensed in the State they are offering these therapies.)

I believe the main recruitment attraction for the telehealth agencies is legitimate licensed providers.

I talked to a recruiter for Doctor on Demand a couple years back and they were paying $65 for each hourly session and I think that was on the high end for these startups, especially ones that are more email/text/subscription based like Betterhelp.

As AA mentioned, the biggest pro is the plug and play piece but you’re majorly limiting your income IMO since it wouldn’t be too difficult to launch your own telehealth only practice that can fit your schedule.

If you were to get paneled, I’m sure you’ll have a steady stream of referrals. Or if you went cash pay only, you should gross more for each hour worked (but would need to put in more time screening patients and handling your own admin).

 

[Ollie123]

I've had several recruiters reach out from these companies that are always offering "competitive salaries." Competitive relative to what is never entirely clear to me, but certainly not any job I've had since graduating. When you factor in the limited benefits they typically offer, its usually not far off from what I pay post-docs.

I don't know anyone who has been a provider for them. I do know a few folks who were patients. Its a biased sample obviously, but my general impression is that a well-meaning "life coach" with no formal mental health training might actually do a better job than the typical therapist on these platforms. I'm sure there's a solid clinician here or there using it for some low-effort side income or something like that, but I don't think that's the norm.

As above, other than making it plug & play I really don't get the appeal. Need for mental health treatment is astronomical right now - I'm not sure it ever really came down from the COVID surge. These companies don't really "do" anything that I can tell besides providing you a telehealth platform you could get yourself for a fairly negligible sum of money (< $100/month I imagine) and a referral base that I can't imagine would be tough to get through other means right now. Basically, outside people who don't have the savings to afford a little ramp-up time, I really don't see any upside for the therapists - even mid-levels, let alone psychologists.

This post should not be construed as an endorsement of well-meaning life coaches with no formal mental health training.

 

[AcronymAllergy]

This was my fear that my future career reputation may be tarnished but I want more flexibility and I maintain a hybrid schedule now (sometimes more virtual versus in-person) so am entertaining branching out on my own.

This is my hope to sustain livelihood for the next few years. I often love my 40-50 hr/wk job but family demands consistently call so I'm now thinking of part-time hours until my youngest child is in college. Letting my assistant professorship will be difficult so I don't want to hinder future opportunities of returning to faculty positions if I do branch out to telehealth PP.

Thank you, @WisNeuro and @AcronymAllergy - your time is much appreciated.

I don't think your reputation would be tarnished, I just think you might be selling yourself short, especially if you don't need to get started now, and instead have time to set up things like your EHR, scheduling, and billing software.

There are numerous folks in my state, per our listserv, who haven't been in their (non-home) office since COVID and are booked solid. Like Ollie and others have said, the need is pretty astronomical and I don't think it's going to slow down anytime soon. There will be folks who prefer in-person, but there will be plenty of others ok with virtual-only. Exponentially so if you're in a PsyPact state.

The only problem I could foresee might be Medicare. Pretty sure they require a physical office address, and I don't know that it can be your home (or that you'd want it to be).

 

[texanpsychdoc]

My day job is as a psychologist with the VA/ assistant professor at an AMC. I work from home 4 days out of the week. I also own and operate a private practice that is 100% remote. Working from home allows me some flexibility to do PP work. I built my practice from the ground up in every way - I filed for my PLLC, I built my own website, I research and apply the latest trends in marketing and networking, I applied to and have been successfully paneled by BCBS, United, Cigna, Aetna, and Humana insurance panels. I have several social media platforms for my practice, thus I tend to make short videos, one of which snagged me an epic wine and dine deal last week at this fancy steak house where the minimum price was $200 for an appetizer, and it was a 3 course meal with drinks. I was re-invited to do this wine and dine experience again this month by this same group dental practice. I have one listing on Psychology Today that outlines my in network status and private pay details. I get about 4-5 calls/emails a day inquiring to see me.

I say all of this because, all of my efforts are directly proportional to my successes, which are really rewarding. Every crappy day I have at the VA, which is basically more days than not, lights a fire under me to continue my efforts to build my practice. I have since advertised open contract positions for my practice so I can take 25% and the contractor takes 75%. If I can hire 4-5 folks, skim 25% from each, that's going to be a nice source of passive income in the long run. For now, I am keeping my costs low, so I do not have a physical office, but I am looking to get one once I can justify it and pay for it out of my practice's capital earnings. My goal is to be able to pay 100% of my business expenses and 75% of my personal expenses for 3 months consistently before I make the decision to finally ditch the VA.

I had the realization that my personality style does not jive well with the VA, and probably working for others LOL. I also want the income, flexibility, quality of life, and practice the way I want....these goals are really not attainable working for others, especially for large healthcare organizations. Thus, PP it is.

 

[smalltownpsych]

I worked for Betterhelp while I was getting my practice up and running so that I would have a little income coming in. I feel like I lost about 20 IQ points, a whole standard deviation! 🤪
Seriously though, the money was horrible and the way that it was designed was counter to my whole way of working with people. I did have a few clients that were appropriate for the platform and benefitted, but most of the time it felt like it was a pointless exercise. One thing about telehealth is that it takes away a little bit of engagement which makes it more boring and tedious for me and some patients and days can be tedious enough.

If you do want to do a little telehealth, I agree with other posters to just go solo. It actually isn’t too hard to do and you could use simplepractice or therapynotes and an ad in psychology today to get it all up and running in no time and for not much cost. There is a lot of business out there and smart people find out pretty quickly that a good psychologist is worth it. I charge almost double what the local midlevels do and don’t take insurance and I am doing just fine.

 

[texanpsychdoc]

I worked for Betterhelp while I was getting my practice up and running so that I would have a little income coming in. I feel like I lost about 20 IQ points, a whole standard deviation! 🤪
Seriously though, the money was horrible and the way that it was designed was counter to my whole way of working with people. I did have a few clients that were appropriate for the platform and benefitted, but most of the time it felt like it was a pointless exercise. One thing about telehealth is that it takes away a little bit of engagement which makes it more boring and tedious for me and some patients and days can be tedious enough.

If you do want to do a little telehealth, I agree with other posters to just go solo. It actually isn’t too hard to do and you could use simplepractice or therapynotes and an ad in psychology today to get it all up and running in no time and for not much cost. There is a lot of business out there and smart people find out pretty quickly that a good psychologist is worth it. I charge almost double what the local midlevels do and don’t take insurance and I am doing just fine.

I really like SP....I have used them for 2 years now, and just recently getting paneled with insurances and having submitted claims through them, I kid you not, I submitted my BCBS claim on Monday and they paid on Wednesday. The first time I submitted it got rejected and I was notified within an hour and it told me the reason (the diagnosis code I put in was in the wrong format), so I deleted the claim and submitted a new one and bam, it fixed it.

 

[Harry3990]

Anyone familiar with current HIPPA compliant phone options (that would work for a telehealth practice, so not a land line)? I am trying to decide between iPlum or google voice (paid version with BAA). Have heard good things about spruce health also, but they seem expensive.

Curious what others use and if they’re happy?

 

[CheetahGirl]

This post should not be construed as an endorsement of well-meaning life coaches with no formal mental health training.

This.

Thank you for your thoughtful reply, @Ollie123 Hope you & yours are thriving well.

 

[SomeGreatNotion]

Anyone familiar with current HIPPA compliant phone options (that would work for a telehealth practice, so not a land line)? I am trying to decide between iPlum or google voice (paid version with BAA). Have heard good things about spruce health also, but they seem expensive.

Curious what others use and if they’re happy?

Telzio works for me! I’m in a group practice so can’t speak to cost but functionality is good.

 

[jspade]

I don't have regrets about making the move to PP Neuropsychology. I was part of a corporate Neuropsych OP Rehab for years before making the change. At first, I made time in my schedule AFTER my day job to start seeing 1-2 patients each day in my own office. Strong cancellation policies helped to minimize no-shows and last minute cancellations. I began to provide my patients with everything they needed in order to file their own insurance claims, but I remain cash-pay only by offering concierge services.

I miss the paid vacation time and the corporate-sponsored 401k and savings plans, but my financial advisor helped with ensuring that I won't need to work until the grave. Another consideration, I waited until my children were out of school and "off the payroll." Minimizing my own personal expenses made the transition easier. Pay off your car, don't carry credit debt, etc.

One of the most challenging aspects for me, and I assume is true for others who made the move to PP, is the initial expense of acquiring materials and supplies. Pearson and PAR will become your frequent friends. Be prepared to spend thousands of dollars on kits and materials.

I appreciated that I could make my transition to PP at my own pace. Once I had 2 patients coming every day after my day job, I dropped back to part-time at work and added another 2-3 patients in my private practice. The entire process for me took about a year and a half before I depended on my PP entirely. Now, I see 4-6 patients per day, a combination of testing, reviewing results, and managing cognitive rehabilitation as well as providing psychotherapy for patients and families. I employ an office manager to handle scheduling, a cognitive rehab specialist for neurorehab and I hired a physician liason to promote my practice within Neurology, Gerontology and Primary Care. Take it a step at a time, do ALOT of planning, and enjoy the freedom that comes with PP. In the long run, I have enjoyed almost every moment.

 

[chicandtoughness]

As another N=1, I hated pp with every bone in my body and insta-regretted it. This was largely because I realized I disliked patient-facing continuous care. I ended up moving to assessments in hospital and utilization review, and could not be happier.

For me, pp in terms of clinical work wasn't horrible. But I didn't want to do all the (unpaid) work of finding new patients lol.

 

[WisNeuro]

As another N=1, I hated pp with every bone in my body and insta-regretted it. This was largely because I realized I disliked patient-facing continuous care. I ended up moving to assessments in hospital and utilization review, and could not be happier.

For me, pp in terms of clinical work wasn't horrible. But I didn't want to do all the (unpaid) work of finding new patients lol.

How much time did this take? I've spent exactly 0 hours doing this in the last year and a half.

 

[texanpsychdoc]

I would add that even the "unpaid" hours I might put into my PP, the benefits (financial and otherwise) are more lucrative than working for others, especially a large healthcare organization. Knowing I have 100% control in what I do, when I want to do it, and how I want to do it is a fringe benefit in itself. Notwithstanding this, the $$ I get in private practice is dwarfing my rate I get as a VA psychologist. So, if I am doing this full time, but also hiring 5-8 other contractors and taking 25% of their earnings, I am having a passive income that could easily allow me to achieve the financial goals I have for myself without having to work. I can take the vacations I want, I can "clock in" whenever I want. There are also other streams of revenue I am implementing such as offering paid consultations for people interested in venturing into psych testing, therapy, and maybe eventually, helping people set up their own private practice (I got these ideas after being approached by like 4 people recently asking if I could consult with them to do adult ADHD evals, and they were willing to pay me). There's also another source of revenue where I can lease property and sub-let that out for extra $$$. In the end, I don't need to price gouge folks while also taking insurance, employing contractors, doing paid consultations, and subletting office space that will give me the financial gains I am looking for. In my mind, I would totally prefer doing the business side of private practice over the clinical. I have had businesses before and love the marketing, web-design, etc. I don't see it as work as it's fun for me. But sure, it's technically "unpaid" hours I am "working."

 

[eeor1006]

I would add that even the "unpaid" hours I might put into my PP, the benefits (financial and otherwise) are more lucrative than working for others, especially a large healthcare organization. Knowing I have 100% control in what I do, when I want to do it, and how I want to do it is a fringe benefit in itself. Notwithstanding this, the $$ I get in private practice is dwarfing my rate I get as a VA psychologist. So, if I am doing this full time, but also hiring 5-8 other contractors and taking 25% of their earnings, I am having a passive income that could easily allow me to achieve the financial goals I have for myself without having to work. I can take the vacations I want, I can "clock in" whenever I want. There are also other streams of revenue I am implementing such as offering paid consultations for people interested in venturing into psych testing, therapy, and maybe eventually, helping people set up their own private practice (I got these ideas after being approached by like 4 people recently asking if I could consult with them to do adult ADHD evals, and they were willing to pay me). There's also another source of revenue where I can lease property and sub-let that out for extra $$$. In the end, I don't need to price gouge folks while also taking insurance, employing contractors, doing paid consultations, and subletting office space that will give me the financial gains I am looking for. In my mind, I would totally prefer doing the business side of private practice over the clinical. I have had businesses before and love the marketing, web-design, etc. I don't see it as work as it's fun for me. But sure, it's technically "unpaid" hours I am "working."

Can you elaborate on the marketing practice you mentioned in the earlier post? I have my own LLC, plan to see no more than 10 pts a week to supplement my day job as an AMC psychologist. Not paneled with any insurances yet (probably never will). So far what I have a website, a Psychologytoday profile, and some networking with other providers in my area for referrals. I get maybe 1-2 calls or emails a week. When I call them back, a lot of times it is either a bad fit, they didn't want to pay out-of-pocket, or my calls go straight to voicemail. Three months into the LLC world, I only have 5 patients who regularly attend sessions. Obviously, the hourly pay I get is still quite a bit higher than my day job rate. I just wonder if there is other things I can do to boost the number of inquires I receive.

 

[texanpsychdoc]

Can you elaborate on the marketing practice you mentioned in the earlier post? I have my own LLC, plan to see no more than 10 pts a week to supplement my day job as an AMC psychologist. Not paneled with any insurances yet (probably never will). So far what I have a website, a Psychologytoday profile, and some networking with other providers in my area for referrals. I get maybe 1-2 calls or emails a week. When I call them back, a lot of times it is either a bad fit, they didn't want to pay out-of-pocket, or my calls go straight to voicemail. Three months into the LLC world, I only have 5 patients who regularly attend sessions. Obviously, the hourly pay I get is still quite a bit higher than my day job rate. I just wonder if there is other things I can do to boost the number of inquires I receive.

I have a PLLC here in Texas. I get about 3-4 calls/emails a day inquiring for services, and things are only ramping up based on the website analytics I am seeing. This all happened about 1.5 months ago after getting paneled with insurances. I am paneled with BCBS, United, Cigna, and soon-to-be Aetna, and I also have a private pay option. I make use of a variety of print and digital marketing strategies (i.e., flyer, brochures, business cards). I literally will "cold call" (email) various healthcare providers around my area, my state, and around other states that are part of PSYPACT. I belong to like 8 Facebook groups (one is a PSYPACT psychologist group) where I routinely post and advertise my practice, and also look at others' advertisements to "put my hat in" for consideration for a referral. I have Google Ads, a Psychology Today profile, I make short videos on various topics that I post to my practice's Facebook, Instagram, Twitter, LinkedIn, and Youtube pages. I make sure my website's SEO is on par to come up in organic listings, I also have a Google Business profile that lists my practice on Google based on its address, so effectively, my practice is coming up in the top 3 sections of Google searches (i.e., the top is for paid ads, the second portion is for address-based business, and the third portion are for organic results). I have been invited to some networking dinners at some nice steakhouses where I pass around my print marketing materials.

Oh, I also do corporate sponsorships for small-time local events (golf tournaments) so that my logo and website are marketed when I donate and sponsor. I also belong to variety of state and national listservs that have my practice information that is routinely marketed there.

Alternatively, I am looking to start creating "on demand" CEU courses that can be passive income for me as long as I can get them accredited by either TPA or my local psychological association.

 

[eeor1006]

I have a PLLC here in Texas. I get about 3-4 calls/emails a day inquiring for services, and things are only ramping up based on the website analytics I am seeing. This all happened about 1.5 months ago after getting paneled with insurances. I am paneled with BCBS, United, Cigna, and soon-to-be Aetna, and I also have a private pay option. I make use of a variety of print and digital marketing strategies (i.e., flyer, brochures, business cards). I literally will "cold call" (email) various healthcare providers around my area, my state, and around other states that are part of PSYPACT. I belong to like 8 Facebook groups (one is a PSYPACT psychologist group) where I routinely post and advertise my practice, and also look at others' advertisements to "put my hat in" for consideration for a referral. I have Google Ads, a Psychology Today profile, I make short videos on various topics that I post to my practice's Facebook, Instagram, Twitter, LinkedIn, and Youtube pages. I make sure my website's SEO is on par to come up in organic listings, I also have a Google Business profile that lists my practice on Google based on its address, so effectively, my practice is coming up in the top 3 sections of Google searches (i.e., the top is for paid ads, the second portion is for address-based business, and the third portion are for organic results). I have been invited to some networking dinners at some nice steakhouses where I pass around my print marketing materials.

Oh, I also do corporate sponsorships for small-time local events (golf tournaments) so that my logo and website are marketed when I donate and sponsor. I also belong to variety of state and national listservs that have my practice information that is routinely marketed there.

Alternatively, I am looking to start creating "on demand" CEU courses that can be passive income for me as long as I can get them accredited by either TPA or my local psychological association.

Very helpful. Thanks! I have a specific population I want to target and I need to think about effective ways to reach them.
If your CEU is on setting up private practice or related topics, keep us posted.

 

[texanpsychdoc]

Very helpful. Thanks! I have a specific population I want to target and I need to think about effective ways to reach them.
If your CEU is on setting up private practice or related topics, keep us posted.

That's a nice idea! I am by no means an expert on the business side of this, as there are others on this forum who are and have been doing it a lot longer than I have, but, I have found methods that have worked for me, so who knows, maybe someone would be willing to pay a little $$ for a CEU to watch/listen about this topic. IDK

 

[WisNeuro]

I have a PLLC here in Texas. I get about 3-4 calls/emails a day inquiring for services, and things are only ramping up based on the website analytics I am seeing. This all happened about 1.5 months ago after getting paneled with insurances. I am paneled with BCBS, United, Cigna, and soon-to-be Aetna, and I also have a private pay option. I make use of a variety of print and digital marketing strategies (i.e., flyer, brochures, business cards). I literally will "cold call" (email) various healthcare providers around my area, my state, and around other states that are part of PSYPACT. I belong to like 8 Facebook groups (one is a PSYPACT psychologist group) where I routinely post and advertise my practice, and also look at others' advertisements to "put my hat in" for consideration for a referral. I have Google Ads, a Psychology Today profile, I make short videos on various topics that I post to my practice's Facebook, Instagram, Twitter, LinkedIn, and Youtube pages. I make sure my website's SEO is on par to come up in organic listings, I also have a Google Business profile that lists my practice on Google based on its address, so effectively, my practice is coming up in the top 3 sections of Google searches (i.e., the top is for paid ads, the second portion is for address-based business, and the third portion are for organic results). I have been invited to some networking dinners at some nice steakhouses where I pass around my print marketing materials.

Oh, I also do corporate sponsorships for small-time local events (golf tournaments) so that my logo and website are marketed when I donate and sponsor. I also belong to variety of state and national listservs that have my practice information that is routinely marketed there.

Alternatively, I am looking to start creating "on demand" CEU courses that can be passive income for me as long as I can get them accredited by either TPA or my local psychological association.

For small enterprises, I would probably abandon this, the time, effort, and expense involved usually cannot keep pace with larger outfits. CEUs are incredibly cheap these days, so you'd probably lose money on hosting duties alone. Add on top that you have to keep documentation of homestudy participants and performance related issues for potential future audits, and it quickly adds up. In most circumstances, this only works with an economy of scale. Heck, most state psych associations either make very small profit, or break even on on demand offerings, and they usually have a much larger infrastructure already in place, along with APA accreditation and hundreds of volunteer hours on hand.

 

[texanpsychdoc]

For small enterprises, I would probably abandon this, the time, effort, and expense involved usually cannot keep pace with larger outfits. CEUs are incredibly cheap these days, so you'd probably lose money on hosting duties alone. Add on top that you have to keep documentation of homestudy participants and performance related issues for potential future audits, and it quickly adds up. In most circumstances, this only works with an economy of scale. Heck, most state psych associations either make very small profit, or break even on on demand offerings, and they usually have a much larger infrastructure already in place, along with APA accreditation and hundreds of volunteer hours on hand.

This makes sense. Glad you brought this up. I will certainly reflect on this more. I do want to do something that allows me to create some type of video content that could be useful to someone that I can charge a modest fee for. I know folks have YouTube channels to promote this very thing (i.e., Private Practice Skills). I will go back to the drawing board.

 

[psychma]

Full-time, private pay, private practice. I started it 1.5 years ago and couldn’t be happier or busier.

 

[GT_Neuro]

You are going to make significantly more $ in the right private practice.

 

[GT_Neuro]

I am looking to hire an assessment-based Child Clinical Psychologist, Adult Clinical Psychologist, and Adult Neuropsychologist for my practice (Charleston Neuropsychology) which is located in Charleston, SC. I recently posted the Adult Neuropsychologist and Child Clinical Psychologist positions on the Job Board.

For the Child & Adult Clinical Psychologist positions you will probably make approximately $105,000 - $135,000 / year. You will probably make in the range of $120,000 - $160,000 / year for the Neuropsychologist position. The pay is based on production and we have a bonus system. Essentially, you have an opportunity to make more $ the more patients you see.

Please feel free to contact me if you may be interested. Also, I would be grateful if you could pass along this information to any interested persons. My email is [email protected]. Our website is www.charlestonneuropsychology.com.

Thanks,

Gordon Teichner, Ph.D., ABPP

 

[fallen625]

Do it. I make over 200k a year while seeing 15 patients a week (private pay, HCOL city). Highly recommend! I still work my main job (academia) because I like it, but I still think often about leaving because the work/pay ratio doesn't really make sense to me.

 

[PsySeeker]

I had about 8 months where I could have and procrastinated and stayed working in a place I should not have. Not going PP sooner, even by a few months, is my only regret.

 

[PsySeeker]

Do it. I make over 200k a year while seeing 15 patients a week (private pay, HCOL city). Highly recommend! I still work my main job (academia) because I like it, but I still think often about leaving because the work/pay ratio doesn't really make sense to me.

Your hourly must be fairly well north of $300 then. How HCOL? Like NYC-Boston-DC metro high?

 

[PsySeeker]

I am looking to hire an assessment-based Child Clinical Psychologist, Adult Clinical Psychologist, and Adult Neuropsychologist for my practice (Charleston Neuropsychology) which is located in Charleston, SC. I recently posted the Adult Neuropsychologist and Child Clinical Psychologist positions on the Job Board.

For the Child & Adult Clinical Psychologist positions you will probably make approximately $105,000 - $135,000 / year. You will probably make in the range of $120,000 - $160,000 / year for the Neuropsychologist position. The pay is based on production and we have a bonus system. Essentially, you have an opportunity to make more $ the more patients you see.

Please feel free to contact me if you may be interested. Also, I would be grateful if you could pass along this information to any interested persons. My email is [email protected]. Our website is www.charlestonneuropsychology.com.

Thanks,

Gordon Teichner, Ph.D., ABPP

it's what's for dinner.