Private practice during the fellowship

[Life-Imitates-Life]

Hey all,

Throwaway account so I don't say/do anything stupid. I will be starting a 1yr fellowship in a large city next year. I have moonlit at various institutions PGY3/4, including a large group with lots of support staff and malpractice coverage, and 1099 work with my own insurance. I've made 100k-200k through PGY3/4 doing this. All pretty legit work as a resident at places that know I am a resident, but pat 150-200/hr.

I am interested in starting a private practice (perhaps telehealth) in my new big city. I will be board certified in September assuming I pass the test (not sure the timeline for results).

How easy is it to set up a practice, pay for an EMR like Valent, e-prescribing, and either rent out an office or do telehealth from home, from 5pm-9pm on weeknights and weekends? I am thinking about 10 hours per week in total. I've seen places charge $200+/hr and give patients documents to get reimbursed through insurance. I know there is a market since the waitlist is 6+ months for a new visit.

Is this easy? Are there resources? I would even pay someone money to help set it up and make sure I have my stuff together.

My plan is to work in academics after, going for PSLF and enjoying academic work, but keeping this side business maybe 1 day per week.

Any help or direction would be appreciated.

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[dl2dp2]

Very easy very doable. Fellowship is a good time to it.

Read the APA guide:

Starting a Practice

An online reference guide for any psychiatrist thinking of starting or changing a practice.

www.psychiatry.org

Depending on the locale, $200 an hour would be on the low end.

The only hickup is PSLF. I know for sure that you *can* do PSLF and also do a practice, but there are income restrictions, and implications for income based repayment. I am not well informed on this, but this is good to check while you start setting things up.


I'd be happy to advise privately if you are interested. PM me.

 

[splik]

This is not uncommon in major metropolitan areas. just make sure you get approval from your program director etc. You will need to report this in your duty hours and get their blessing. If it is an area with lots of psychiatrists and a chill fellowship, this should not be an issue. but some programs do prohibit this. always good to ask about when interviewing for programs.

 

[Gavanshir]

I'm CAP-1 and doing similar kind of moonlighting (though I'm only doubling my salary ). It seems to me to be much easier to just continue doing the same moonlighting that you're doing since you're making good money, why bother with the hassle of private practice right now? Can you give us an idea of what region of the country you're in?

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[Celexa]

Very easy very doable. Fellowship is a good time to it.

Read the APA guide:

Starting a Practice

An online reference guide for any psychiatrist thinking of starting or changing a practice.

www.psychiatry.org

Depending on the locale, $200 an hour would be on the low end.

The only hickup is PSLF. I know for sure that you *can* do PSLF and also do a practice, but there are income restrictions, and implications for income based repayment. I am not well informed on this, but this is good to check while you start setting things up.


I'd be happy to advise privately if you are interested. PM me.

There are certainly income based payment implications (although you will always have more money by making more money) but there are no income limits on PSLF. The requirement is to work a certain number of hours per week for a qualifying employer and make 120 payments while enrolled in qualifying IBR payment plans. Work in addition to the qualifying work does not affect eligibility.

 

[MacDonaldTriad]

All ACGME accredited programs are required to have a moonlighting policy. The ACGME doesn't care what it says, we just have to have one. It is probably in a fellowship manual or a web site for you to see. Violating what ever the policy is isn't a good idea.

 

[whopper]

Before doing this figure out will you have the time to do this? Also if you're in a great fellowship you might killing some learning opportunities cause part of your mind won't be on fellowship but your PP if you made one during fellowship.

 

[FatherPsychiatry]

Re: PSLF requirements - 30 hours per week for a qualifying employer. Additional income doesn't affect that eligibility (1099, W2, whatever), although obviously if you earn more money overall, your monthly payments will go up to the point your minimum payments may pay off the loan before you make your 120th payment.

 

[Merovinge]

Re: PSLF requirements - 30 hours per week for a qualifying employer. Additional income doesn't affect that eligibility (1099, W2, whatever), although obviously if you earn more money overall, your monthly payments will go up to the point your minimum payments may pay off the loan before you make your 120th payment.

A great problem to have, as a number of people who think they want to do academics later see the $150,000 pay cut they are taking and the bureaucracy layers and stick it out just to complete the PSLF. More options, more flexibility mean more happiness and you taking better care of your patients.

 

[clozareal]

The extra income is more of a problem if you are doing income driven repayment. Payments are calculated based on HHS poverty amount x 150% = Income Protection Allowance (IPA). Then take adjusted gross income (AGI) - IPA = discretionary income (DI). You then take DI x 15% in income based repayment (IBR) or DI x 10% in PAYE or REPAYE = annual payment, then divide by 12 months to get monthly payment. You must use an income driven repayment to do PSLF.

Depending on how much you make, you may pay off the loans faster than the 10 years in PSLF. You can try to make the calculations yourself with the formulas above. To make it easier, you can look at this chart below that would help you find out if PSLF is worth it or not. Green = no forgiveness is possible. Yellow = possible, not worth the hassle. Orange = probable worth it. Red = definitely worth it.

Is PSLF Worth It for Doctors? | White Coat Investor

Deciding to go for Public Service Loan Forgiveness is a big decision. We ran the numbers to help attending physicians decide if PSLF is your best option.

www.whitecoatinvestor.com