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Sushi, do you meet pts primarily in-person or tele? Just curious.
Private Practice in Progress
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Consults are in person. Unless they are calling from my old office location and would be suitable for 100% tele.
After seen for the initial consult, its up to the patient to decide future visits for in office or tele. *unless controlled substances, I'll require certain frequency of in office visits. I'd say about 60% opt for tele, 40% prefer in office.
After seen for the initial consult, its up to the patient to decide future visits for in office or tele. *unless controlled substances, I'll require certain frequency of in office visits. I'd say about 60% opt for tele, 40% prefer in office.
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Is the Payroll for wages, taxes, and SEP-IRA for your assistant? That together is about 18% of your gross revenue, so pretty big overhead cost.
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Yes, those are for the assistant. It is a big piece of the overhead. However, with this being an insurance based practice the amount of work done, its worth every penny. With out that work, I couldn't do it all. Simply impossible. I'm always fortunate her skills are on the upper end of customer service, and she's dependable, and likes the part time nature to current work hours.
If I were say, at ~200 patients and having ~16 clinical hours per week of work, that could in theory equal Gross of ~283K and the overhead would be very similar to that current ~50k mark. So here on up, growth is money in pocket. I just need to get away from this inflection point on the graph of fixed costs. It is a glaring light on why, if doing insurance, people shouldn't think of a light part time practice but focus on a moderate to full time level of practice if doing insurance based, because of the fixed overhead.
I could possibly stop paying monthly website maintenance of $100/month and pocket 1200 more per year, but then if website goes down, I have to figure that out. So as tempting as that is for a low lying fruit, I'll likely not strike it.
If I were say, at ~200 patients and having ~16 clinical hours per week of work, that could in theory equal Gross of ~283K and the overhead would be very similar to that current ~50k mark. So here on up, growth is money in pocket. I just need to get away from this inflection point on the graph of fixed costs. It is a glaring light on why, if doing insurance, people shouldn't think of a light part time practice but focus on a moderate to full time level of practice if doing insurance based, because of the fixed overhead.
I could possibly stop paying monthly website maintenance of $100/month and pocket 1200 more per year, but then if website goes down, I have to figure that out. So as tempting as that is for a low lying fruit, I'll likely not strike it.
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Your obviously improving year over year esp with the decrease in overhead.
Would you ever consider consolidating your practice into 1-2 days and supplement it with another job till your practice fills up fully?
Would you ever consider consolidating your practice into 1-2 days and supplement it with another job till your practice fills up fully?
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Those thoughts cross my mind at times.
New rural location just made such options geographically farther; and as I'm the more active parent for kid stuff I can't flip the switch for work-a-holic. Fully capable of doing that, but with me being more the 'soccer mom' I have less possible work time, and need to optimize it, which leaves me right where I am.
Get more patients up to volume "Full"
Then cut out medicare and lower paying insurance
Get back to full.
Re-evaluate what to do. Build office? Go for building equity? Expand to bring on psychologists? Make no changes and just dump money into farming to leave medicine as fast as possible?
New rural location just made such options geographically farther; and as I'm the more active parent for kid stuff I can't flip the switch for work-a-holic. Fully capable of doing that, but with me being more the 'soccer mom' I have less possible work time, and need to optimize it, which leaves me right where I am.
Get more patients up to volume "Full"
Then cut out medicare and lower paying insurance
Get back to full.
Re-evaluate what to do. Build office? Go for building equity? Expand to bring on psychologists? Make no changes and just dump money into farming to leave medicine as fast as possible?
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This looks good especially for essentially starting over in new state. Personally I wouldn’t sell myself short and would instead look at it as $71.8 in my pocket. The tax deferred in SEP plus growth will be in your pocket one day.
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That's pretty pricey. What goes into that $100/mo? I pay $20/mo for my website through Wordpress (now transferred to SquareSpace) and it's never gone down.
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I guess it depends on what you are doing with your website. If it's just a basic HTML website, you don't need to pay that much money. I use Github Pages (with Github Pro) and Namecheap. It costs $48/year for Github Pro (which is necessary to keep your repository private) and $16/year for the domain name on Namecheap.
I just edit the HTML files myself when I want to make a change. This is very easy with the ability to view the changes yourself (because it is HTML, so you can just open the file locally in your browser before you drag it to Github pages to upload it) and the new LLMs. Maybe I'm missing something, but I don't see why it is necessary to pay more than this.
If you're doing something complicated like a patient portal, that's a different story.
I just edit the HTML files myself when I want to make a change. This is very easy with the ability to view the changes yourself (because it is HTML, so you can just open the file locally in your browser before you drag it to Github pages to upload it) and the new LLMs. Maybe I'm missing something, but I don't see why it is necessary to pay more than this.
If you're doing something complicated like a patient portal, that's a different story.
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Minor update. Q2 this year was new record high for the life of this practice for Gross Income and Net Income.
Hope the trend continues up.
Still mulling over canceling the website maintanence cost.
Hope the trend continues up.
Still mulling over canceling the website maintanence cost.
Great post. I used the invaluable information in this to start my own practice. Highly recommend bookmarking it for any fellows looking to start on their own. Thanks for posting this long ago Sushirolls 👍
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Thoughts on starting a private practice in PGY4? Could this turn a profit/attract patients? Would it have to be cash only because insurance wouldn’t reimburse me as non board eligible for the first 6 months? I don’t know how I would advertise myself, don’t feel comfortable saying I am a psychiatrist just yet (though my understanding is that’s incredibly not a protected term). I do feel like I could do a decent job if selecting patients carefully once done with my outpatient year, and have money to get it going from other moonlighting. Alternatively, could look at working with a company during pgy4 for outpatient. I just like the idea of getting a small (1 day a week ideally) private practice set up asap. Would love to hear if anyone did this during residency.
As others have echoed, really appreciate the blue print for getting things set up, regardless.
As others have echoed, really appreciate the blue print for getting things set up, regardless.
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You are a psychiatrist with 3 years of experience who is finishing their final year of residency and will become board-eligible in X months. Don't sell yourself short.
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Say you are a Psychiatric trained physician, or Psychiatric Focused Physician.
Solicit the same way as others, provide your card when you are on inpatient unit - get approval from PD first before soliciting from training populations. Or even the residency clinic.
The bigger issue, is this just a small time block clinic for moonlighting goals? Or is this your home where you plan to stay after training and will continue the clinic? A PD is more likely to give their blessing if you are staying, i.e. patient continuity. But if you are leaving you need to have another younger resident on standby to take over July 1st. There was PGY3 years ago, at CCF, who got a cash suboxone clinic going during the era of DEA X waivers, and that resident did the clinic on weekends and handed off to younger resident once finished training.
You'll need a website, office space, etc. By opening it up now, you will get the headache of establishing it done, and working out some kinks early, so once you are done with training its ready to blossom. So lower expectation of it being money maker, and assume it will lose money, but your prep work will be complete, and that's something!
Solicit the same way as others, provide your card when you are on inpatient unit - get approval from PD first before soliciting from training populations. Or even the residency clinic.
The bigger issue, is this just a small time block clinic for moonlighting goals? Or is this your home where you plan to stay after training and will continue the clinic? A PD is more likely to give their blessing if you are staying, i.e. patient continuity. But if you are leaving you need to have another younger resident on standby to take over July 1st. There was PGY3 years ago, at CCF, who got a cash suboxone clinic going during the era of DEA X waivers, and that resident did the clinic on weekends and handed off to younger resident once finished training.
You'll need a website, office space, etc. By opening it up now, you will get the headache of establishing it done, and working out some kinks early, so once you are done with training its ready to blossom. So lower expectation of it being money maker, and assume it will lose money, but your prep work will be complete, and that's something!
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Much appreciated.
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I appreciate this.
I would like to have 1-2 days a week of a private practice alongside locums once I graduate so this would work towards that. One issue is that I don’t currently live where I will be practicing (though do have a state license there and in the state I am training in) so visits would need to be virtual until I move.
I am not concerned with my PD’s permission, they are very likely to approve, very supportive.
Also not a huge concern that it wouldn’t be a money maker- interested in the process and getting the paperwork done while I may have some time to twiddle my thumbs during fourth year. Though, I’d hope to at least bring something in. Would any insurance/medicaid/medicare reimburse for this, or would it make most sense to stick to only cash?
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Short answer stick to cash, maybe explore slowly one insurance at a time. But you will most likely need an office lease in that area.
A lot of things will tie back in to needing an address / office in that location.
A lot of things will tie back in to needing an address / office in that location.
notEinstein
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This thread was interesting to read.
As someone who has a degree in business and ran companies for a decade before deciding to going back to school for medicine, this thread reinforced that physicians should receive some business training as well. Many avoidable mistakes.
A few, off the top of my head:
- Forcing people to complete intake forms on the website before they set an appointment? MBA’s brains are exploding everywhere reading that. I get it - healthcare workers don’t like MBA’s (but they’re good at making money!). There is a reason why very few practices do this.
- We would often advise our clients that their only job the first year in business should be to get people in the door. Thats it. It doesn’t matter if they make a follow up appt. It doesn’t matter if they complete the intake forms. It doesn’t matter if you ever see them again. It doesn’t matter if you make a profit. Just get. them. in. the. door. Even if you never see them again, they will 1) remember you and 2) will undoubtably mention you to someone (even if it’s just in passing “oh yeah, I saw that doctor before”). Over time, this word of mouth adds up. A lot.
- When choosing a location, ALWAYS pick a location that fills one of these two options:
a) Next to numerous other physicians. PCP’s, specialists, dentists, etc. You ever notice how McDonalds and Burger King and Taco Bell and other fast food places are all near each other? There is a reason for this. This doesn’t mean psychiatry practices are similar to fast food - just that there is principal behind location sharing (I can go further into this if anyone prefers).
b) If A is not an option, look for a location next to or across from a large grocery store. Especially great if you can find a location that is across from the stoplight where people leave the grocery store. When they’re sitting at that light, every single week after buying groceries, they’re staring at your sign.
- Google Ads was not given nearly enough time or money. There is a rule of 7 in marketing - customers need to see your ad (on average) 7 times before they commit to buying/booking something from/with you. Therefore, Google ads needs at least a year (minimum) to garner the necessary analytics before you judge results, and you also need to spend WAY more than $100 per month on it. Think more like $500-$700 per month.
- Paying over $4,000 upfront and $700 per year for website maintenance?!? This should be $0 per year (aside from hosting) and a very small upfront fee. Pay someone to set up a wordpress website one time ($250-$500 on a freelance websites) and then you can update it yourself, whenever you want, without any coding necessary. It’s like using microsoft word. You just type and the changes take affect. This should be a one time fee and the one time fee includes the freelancer incorporating your EMR into the website.
- Once people arrive on the website, you need a way to keep marketing to them. One way to do this is a google/facebook pixel. This attaches a small piece of code to their browser, so that when they leave your website, they continue seeing your ads and information about you even when they are on other websites. This reduces the amount of time to reach the rule of 7. Another way is to capture email addresses and then send monthly emails with the latest in psych news. This also keeps your name in peoples minds.
Here is an image I made with the help of ai that helps explain in visual form:
Forget efficiency as a new business. Efficiency modeling is a luxury that businesses can undertake AFTER they are full. Trying to force efficiency when you are struggling to get a full panel is a recipe for failure. Just get customers in the door! On the business side, that is your ONLY job. At one point sushi was excited to get loans to build… with not many patients! Priorities!
A friend’s wife started an orthodontics practice from the ground up using the methods above and they are huge now. Staff of 10+ people, huge panel, waiting list, etc.
I have zero doubt that this practice could have been stuffed full in the first year if sushi had someone with a business background on their side. And it’s not his/her fault - medical schools just don’t teach this stuff.
As someone who has a degree in business and ran companies for a decade before deciding to going back to school for medicine, this thread reinforced that physicians should receive some business training as well. Many avoidable mistakes.
A few, off the top of my head:
- Forcing people to complete intake forms on the website before they set an appointment? MBA’s brains are exploding everywhere reading that. I get it - healthcare workers don’t like MBA’s (but they’re good at making money!). There is a reason why very few practices do this.
- We would often advise our clients that their only job the first year in business should be to get people in the door. Thats it. It doesn’t matter if they make a follow up appt. It doesn’t matter if they complete the intake forms. It doesn’t matter if you ever see them again. It doesn’t matter if you make a profit. Just get. them. in. the. door. Even if you never see them again, they will 1) remember you and 2) will undoubtably mention you to someone (even if it’s just in passing “oh yeah, I saw that doctor before”). Over time, this word of mouth adds up. A lot.
- When choosing a location, ALWAYS pick a location that fills one of these two options:
a) Next to numerous other physicians. PCP’s, specialists, dentists, etc. You ever notice how McDonalds and Burger King and Taco Bell and other fast food places are all near each other? There is a reason for this. This doesn’t mean psychiatry practices are similar to fast food - just that there is principal behind location sharing (I can go further into this if anyone prefers).
b) If A is not an option, look for a location next to or across from a large grocery store. Especially great if you can find a location that is across from the stoplight where people leave the grocery store. When they’re sitting at that light, every single week after buying groceries, they’re staring at your sign.
- Google Ads was not given nearly enough time or money. There is a rule of 7 in marketing - customers need to see your ad (on average) 7 times before they commit to buying/booking something from/with you. Therefore, Google ads needs at least a year (minimum) to garner the necessary analytics before you judge results, and you also need to spend WAY more than $100 per month on it. Think more like $500-$700 per month.
- Paying over $4,000 upfront and $700 per year for website maintenance?!? This should be $0 per year (aside from hosting) and a very small upfront fee. Pay someone to set up a wordpress website one time ($250-$500 on a freelance websites) and then you can update it yourself, whenever you want, without any coding necessary. It’s like using microsoft word. You just type and the changes take affect. This should be a one time fee and the one time fee includes the freelancer incorporating your EMR into the website.
- Once people arrive on the website, you need a way to keep marketing to them. One way to do this is a google/facebook pixel. This attaches a small piece of code to their browser, so that when they leave your website, they continue seeing your ads and information about you even when they are on other websites. This reduces the amount of time to reach the rule of 7. Another way is to capture email addresses and then send monthly emails with the latest in psych news. This also keeps your name in peoples minds.
Here is an image I made with the help of ai that helps explain in visual form:
Forget efficiency as a new business. Efficiency modeling is a luxury that businesses can undertake AFTER they are full. Trying to force efficiency when you are struggling to get a full panel is a recipe for failure. Just get customers in the door! On the business side, that is your ONLY job. At one point sushi was excited to get loans to build… with not many patients! Priorities!
A friend’s wife started an orthodontics practice from the ground up using the methods above and they are huge now. Staff of 10+ people, huge panel, waiting list, etc.
I have zero doubt that this practice could have been stuffed full in the first year if sushi had someone with a business background on their side. And it’s not his/her fault - medical schools just don’t teach this stuff.
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I can’t speak for Sushi’s goals, maybe the above would have helped with them.This thread was interesting to read.
As someone who has a degree in business and ran companies for a decade before going back to school for medicine, this thread reinforced that physicians should receive some business training as well. Many avoidable mistakes that are business-101. In fact there were multiple times throughout this thread that I openly wondered whether sushi was trying to make things as hard as possible for him/her (as a challenge).
A few, off the top of my head:
- Forcing people to complete intake forms on the website before they set an appointment? MBA’s brains are exploding everywhere reading that. I get it - healthcare workers don’t like MBA’s (but they’re good at making money!). There is a reason why very few practices do this. Your excuse for doing this is lack of quality chart, lack of follow-ups, etc, which leads me to my next point…
- Your only job the first year in business should be to get people in the door. Thats it. It doesn’t matter if they make a follow up appt. It doesn’t matter if they complete the intake forms. It doesn’t matter if you ever see them again. It doesn’t matter if you make a profit. Just get. them. in. the. door. Even if you never see them again, they will 1) remember you and 2) will undoubtably mention you to someone (even if it’s just in passing “oh yeah, I saw that doctor before”). Over time, this word of mouth adds up. A lot.
- When choosing a location, ALWAYS pick a location that fills one of these two options:
a) Next to numerous other physicians. PCP’s, specialists, dentists, etc. You ever notice how McDonalds and Burger King and Taco Bell and other fast food places are all near each other? There is a reason for this.
b) If A is not an option, look for a location next to or across from a large grocery store. Especially great if you can find a location that is across from the stoplight where people leave the grocery store. When they’re sitting at that light, every single week after buying groceries, they’re staring at your sign.
- Google Ads was not given nearly enough time or money. There is a rule of 7 in marketing - customers need to see your ad (on average) 7 times before they commit to buying/booking something from/with you. Therefore, Google ads needs at least a year (minimum) to garner the necessary analytics before you judge results, and you also need to spend WAY more than $100 per month on it. Think more like $500-$700 per month.
- Paying over $4,000 upfront and $700 per year for website maintenance?!? This should be $0 per year (aside from hosting) and a very small upfront fee. Pay someone to set up a wordpress website one time ($250-$500 on a freelance websites) and then you can update it yourself, whenever you want, without any coding necessary. It’s like using microsoft word. You just type and the changes take affect. This should be a one time fee and the one time fee includes the freelancer incorporating your EMR into the website.
- Once people arrive on the website, you need a way to keep marketing to them. One way to do this is a google/facebook pixel. This attaches a small piece of code to their browser, so that when they leave your website, they continue seeing your ads and information about you even when they are on other websites. This reduces the amount of time to reach the rule of 7. Another way is to capture email addresses and then send monthly emails with the latest in psych news. This also keeps your name in peoples minds.
Here is an image I made with the help of ai that helps explain in visual form:
Forget efficiency as a new business. Efficiency modeling is a luxury that businesses can undertake AFTER they are full. Trying to force efficiency when you are struggling to get a full panel is a recipe for failure. Just get customers in the door! On the business side, that is your ONLY job. At one point sushi was excited to get loans to build… with not many patients! Priorities!
A friend’s wife started an orthodontics practice from the ground up using the methods above and they are huge now. Staff of 10+ people, huge panel, waiting list, etc.
I have zero doubt that this practice could have been stuffed full in the first year if sushi had someone with a business background on their side. And it’s not his/her fault - medical schools just don’t teach this stuff.
For the private practice I recently set up, getting people in the door is not the first goal. Tracking and marketing through all the methods you describe (that make the Internet horrible) are also not goals. Growth via expansion to having staff are not goals and accomplishing that reflects something else entirely (usually, wanting to maximize money).
I agree there is a lot of space for physicians to learn about business but over emphasis on it just leads to maximizing revenue and growth, which are usually accompanied by compromises in the medicine.
notEinstein
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This is often why businesses fail.
Even if your long-term goals are better care for patients with less income, getting people in the door early creates the financial runway, patient base, and operational proof that make those ideals achievable. Initial volume stabilizes cash flow, lowers per-patient costs, generates outcomes data, and builds community trust, all of which give you the freedom later to slow down, charge less, or redesign care without risking the collapse of the practice.
I watched a neurology practice in Upstate NY collapse a few years ago because it tried to prioritize a low-volume, more medically sound care model before establishing sufficient patient flow to sustain the business. Two really great, kind hearted, empathic doctors lost a lot. They were trying to do better for their patients (and they did), but they didn’t realize that their business model was unsustainable if they didn’t create a runway.
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So much terrible advice here I don't know where to start. This shows a complete lack of understanding of the business of medicine in general, and psychiatry practice in particular. Business 101 does not apply in its unadulterated form.
Filling a psychiatric practice is a lot like playing Russian roulette. Our first job is not getting people in the door. It is dodging the bullet of the nightmare patient. I do think some people can be a bit rigid in terms of their forms and other requirements, but we do need to make it a bit challenging in order to keep bad patients out. Its only takes one nightmare patient to totally ruin you with negative reviews, frivolous medical board complaints, lawsuits etc. As such, some degree of gatekeeping is required. This does make it it a bit slower to fill a practice, but it is better to wait than to fill your practice with patients who can destroy your reputation, livelihood, and sanity.
Also, while you can certainly get patients referred by other patients, this is far, far less likely to happen in psychiatry. And professional ethics can prevent us from treating those who are closely related or involved with existing (and sometimes prior) patients.
I would partially agree with a) but not for the fast food analogy reason. It's very reasonable to have your office in a medical building and you make get referrals from other specialists. Even better, have your office in a building with therapists. The therapists will refer to you, you can build community, and the office space is usually dramatically cheaper than medical office space.
Most people aren't thinking about their psych care when buying milk and eggs. Most of our offices tend to be discreet so they aren't going to "staring at your sign".
Even google will tell you not to throw money at the same strategy for more than 3 months without results. So no, definitely do not spend at least a year on this to judge the results. The amount of money needed depends on your location and whether you are cash or insurance. In general, a minimum of $1000 a month is recommended to get enough clicks. For an insurance practice, $1500 a month might be reasonable, for a cash practice you're looking at at least $2500 and maybe $4k+ a month in ad costs in order to make in worthwhile. For a cash practice it might cost you $400-800 or more in ads to get one new patient. This is going to be variable on your location, market saturation, and your ability to close on leads. For most people, it doesn't make sense to invest in that even though the ROI is still solid.
Patients will book with you if one or more of the following apply 1) you are located close to their home or office 2) you are available immediately or very soon and/or 3) you offer precisely the kind of services or experience/niche they are looking for. For that, they only need to hear of you once.
The best referral sources are their own trusted physicians or therapists. Most of my referrals come from a small handful of physicians and psychologists and of those who contact me 90-95% will become a patient. These are usually all pre-vetted by colleagues too so far less likely to be a nightmare patient.
Filling a psychiatric practice is a lot like playing Russian roulette. Our first job is not getting people in the door. It is dodging the bullet of the nightmare patient. I do think some people can be a bit rigid in terms of their forms and other requirements, but we do need to make it a bit challenging in order to keep bad patients out. Its only takes one nightmare patient to totally ruin you with negative reviews, frivolous medical board complaints, lawsuits etc. As such, some degree of gatekeeping is required. This does make it it a bit slower to fill a practice, but it is better to wait than to fill your practice with patients who can destroy your reputation, livelihood, and sanity.
Also, while you can certainly get patients referred by other patients, this is far, far less likely to happen in psychiatry. And professional ethics can prevent us from treating those who are closely related or involved with existing (and sometimes prior) patients.
I would partially agree with a) but not for the fast food analogy reason. It's very reasonable to have your office in a medical building and you make get referrals from other specialists. Even better, have your office in a building with therapists. The therapists will refer to you, you can build community, and the office space is usually dramatically cheaper than medical office space.
Most people aren't thinking about their psych care when buying milk and eggs. Most of our offices tend to be discreet so they aren't going to "staring at your sign".
Even google will tell you not to throw money at the same strategy for more than 3 months without results. So no, definitely do not spend at least a year on this to judge the results. The amount of money needed depends on your location and whether you are cash or insurance. In general, a minimum of $1000 a month is recommended to get enough clicks. For an insurance practice, $1500 a month might be reasonable, for a cash practice you're looking at at least $2500 and maybe $4k+ a month in ad costs in order to make in worthwhile. For a cash practice it might cost you $400-800 or more in ads to get one new patient. This is going to be variable on your location, market saturation, and your ability to close on leads. For most people, it doesn't make sense to invest in that even though the ROI is still solid.
4k was probably a lot at the time, but it can be worth it to invest in a good website. I used to have self-designed one with about $15-20 a month in fees not including the domain name. I paid about $1500 to get my website designed and I pay about $500-600 a year now in hosting and domain name fees etc. Most psychiatrists have truly terrible website. The minimum is to actually have information about your services, your qualifications, availability, contact and scheduling etc. It really does help to invest in decent content, decent photos and images, perhaps a video introducing yourself etc. I cringe when I see everyone with the same square space therapy website. That might be okay if you don't rely on your website to get patients, but for those that do, having a good website is essential otherwise any money spent on ads is just wasted. Honestly, much more worth it to spend a few grand on a website than $30-50k in google ads.
I would strongly advise against this. Paranoid patients or patients seeking discreet professional psychiatric care absolutely don't want you abusing their meta data and stalking them on the internet (which is how this will come across). No one who understands business (let alone medicine/psychiatry) would think the marketing rule of 7s applies to psychiatry. People don't seek out care on a whim or from desire, they don't need to see or hear of you 7 times. That can be a massive turn off.
Patients will book with you if one or more of the following apply 1) you are located close to their home or office 2) you are available immediately or very soon and/or 3) you offer precisely the kind of services or experience/niche they are looking for. For that, they only need to hear of you once.
The best referral sources are their own trusted physicians or therapists. Most of my referrals come from a small handful of physicians and psychologists and of those who contact me 90-95% will become a patient. These are usually all pre-vetted by colleagues too so far less likely to be a nightmare patient.
notEinstein
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Much of this is incorrect (or more accurately - misunderstood), but I do not want to devolve OP’s thread any further with a lengthy point-by-point rebuttal.
For future readers desperate to save their practice and weighing the conflicting advice presented here: I have led a multimillion-dollar organization and held senior management roles across multiple companies before going back to school for medicine; the other poster does not have this experience. Likewise, one MBA from Carnegie Mellon, and the other does not.
This creates a stark knowledge imbalance. It is akin to a well-meaning but naive patient arguing with you about medicine because of what they saw on TikTok. They have bits and pieces of information but lack the fundamental understanding that is required to apply those pieces. They are *so* certain that they are right (and will argue nonstop).
Put another way: There is a reason hospitals rely on experienced business professionals to run operations rather than physicians. There is a reason why the largest psychiatry practice in our city runs the exact methods I described earlier.
Sorry for any misspelling - using talk to text. I wish everyone success and respectfully bow out. You may PM me with questions if you’d like.
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I think you two are arguing different points. When the only goal is money, you are correct in that you do anything to get patients in the door. Most of us in psychiatry have 0 interest in just maximizing revenue or we would have chosen a different field.
Most here want to build a practice that is fulfilling, benefit patients on an individual level, and minimize stress. Sure we want to make decent money, but I’d rather my practice fail and get an hourly job than build something that is solely focused on money.
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Hang on, you didn't go back to school for medicine. You posted two weeks ago that you just got accepted to a DO school off the waitlist. So at best, you can call yourself a pre-med student. Don't misrepresent yourself (it just makes us wonder how else you're misrepresenting yourself when talking about "running companies" and holding "senior management roles".)
My wife has an MHA and held a management position at multibillion-dollar organization before helping me with my private practice. The skillset that it takes to launch and develop a private practice is completely different than the skillset it takes to run a large organization (or, more often, a department within a large organization). We found the most help from Facebook groups, not her business school textbooks or even her year of admin fellowship.
Even if the goal was to maximize money, which it isn't for most of us (we don't need an MBA to teach us how to operate a pill mill), getting the most people in the door is not the way to do this. I would be interested in learning from you how filling up a practice with Medicaid patients is going to maximize my profit (I could quickly generate a waitlist 5 years long by accepting Medicaid today and calling up all the ERs in the city, letting them know I'm open for business).
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This is a public forum, and my posting history is right there. I’ve been clear about my background for the past year: I spent two decades in business leadership, then went back to school two years ago to start my medical path by completing prerequisites. I’ve since interviewed at six schools and been accepted to four (MD and DO).
So I’m not sure where the “misrepresentation” idea is coming from. The only thing I can think is that “back to school for medicine” got read as “already finished medical school”—that’s not what I meant, and I apologize if my wording gave that impression despite my long posting history saying otherwise.
Okay, that’s fair. If maximizing practice potential and income is not what you want, then my advice is not right for you.
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I have been an analyst for a few practices who did some nefarious billing to drive this number up… I don’t suggest it. Also ran into some over-documenters who ended up doing more harm than good during audits where every word gets picked on.
On the flip side, I have found that many practices don’t properly bill. It is the first thing we would look at. Many leave codes on the table that they should be charging. PM me and I can in fact help with this.
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@notEinstein has presented a model to be the next wildfire telehealth flavor psychiatry practice, that further expands in a manner that might get within the crosshairs of various regulators, or a heck of PE buyout. To at least see some positives, it is a model, and can lead to a type of success, and others reading might see the value in those posts. We can't completely raze those concepts to the ground. I am curious to see how impressions will change, once medical school and residency are underway/completed. If the sapling of a physician grows so that its foliage crown drowns out the shrub of a businessman, or if the beating heart of the business capitalist simply breathes a new flame thru the scales of a harden physician.
[*Positively the poster got in and isn't another SJW. **Do keep your head down and your opinions low thru med school and residency. There is a risk of lib commie types who won't stop with a balanced give/take discussion on the longer stretches of hospital hallways between patients but actually want to clip your wings.]
It can also be a model to build up psych hospitals that could compete with UHS. I briefly graced one such place that was in rapid expansion mode before I realized exactly what they were (and are about), and quickly exited within a few months.
There is also a not yet mentioned angle of caution towards the business focused drive posited by @notEinstein. Medicine is littered with the graveyard of outsiders trying to prove and fix healthcare. Amazon has a mail order pharmacy, and I vaguely recall they even tried to have their own medical clinics. Another organization also tried to spawn medical clinics and they pulled out, I can't remember whom. Or the IT sector stating they can LLM their way thru to optimization. One only needs to experience being on call for IM, and doing an admission to the ICU of a medical train wreck who has a PAPER chart thicker than my foot is long; or the personality disordered fire in full on flame mode, or the anxious cognitive decline patient who is struggling to sleep/anxiety/mood/family to realize AI and big tech will have long way before conquering medicine.
Mayo Clinic, Cleveland Clinic are physician run and arguably the best of healthy systems in the country or even the world - one can thru a stone at MBA run hospitals that repeatedly choke their organization with poor choices; I can point out a long list of them that have directly impacted me, friends, family, or patients. Long live the physician run orgs, even despite their warts.
[*Positively the poster got in and isn't another SJW. **Do keep your head down and your opinions low thru med school and residency. There is a risk of lib commie types who won't stop with a balanced give/take discussion on the longer stretches of hospital hallways between patients but actually want to clip your wings.]
It can also be a model to build up psych hospitals that could compete with UHS. I briefly graced one such place that was in rapid expansion mode before I realized exactly what they were (and are about), and quickly exited within a few months.
There is also a not yet mentioned angle of caution towards the business focused drive posited by @notEinstein. Medicine is littered with the graveyard of outsiders trying to prove and fix healthcare. Amazon has a mail order pharmacy, and I vaguely recall they even tried to have their own medical clinics. Another organization also tried to spawn medical clinics and they pulled out, I can't remember whom. Or the IT sector stating they can LLM their way thru to optimization. One only needs to experience being on call for IM, and doing an admission to the ICU of a medical train wreck who has a PAPER chart thicker than my foot is long; or the personality disordered fire in full on flame mode, or the anxious cognitive decline patient who is struggling to sleep/anxiety/mood/family to realize AI and big tech will have long way before conquering medicine.
Mayo Clinic, Cleveland Clinic are physician run and arguably the best of healthy systems in the country or even the world - one can thru a stone at MBA run hospitals that repeatedly choke their organization with poor choices; I can point out a long list of them that have directly impacted me, friends, family, or patients. Long live the physician run orgs, even despite their warts.
Amen, @TexasPhysician. Routinely the route of maximizing patients is a click or prescription away, but it's not what I'd personally want, nor my kin and I stay the course.
@Atreides many years back during residency, I had a chance to socialize with a resident from a different program, and they described how their parent was a Psychiatrist and had a volume based practice seeing mostly medicaid and doing essentially 10 minute appointments. Their income ~15 years ago was supposedly in the 500k range. So a rumored, old, N of 1, could support a medicaid volume practice - but we all know there other issues that would come with that and why most every psychiatrist chooses not to go down that path.
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@notEinstein reminds me of the talk I had with an exec of a large telehealth org back when they were trying to recruit me. When I asked about their mission and model, it was clearly a high volume, maximize profit sorta thing. Ofc they disguised it with a healthy dose of solving the mental health “shortage” crisis (PSA: shortage no longer exists with pts on regular insurance, partly due to these companies lol).
I sometimes check-in with my former co-residents that ended up joining one of those, and they all hate it. Sure you may be able to get some extra cash vs if you worked for a true nonprofit based MH gig. But if your priority is maximizing money thru seeing the maximum number of people, while at the same time also going heavy duty on the business side of things, you’re going to burn out pretty quickly.
If you’re set on this model though and starting med school soon, I suggest going for a surgical subspecialty and applying your plan there. Higher margin per patient, your field is relatively safe from encroachment, and your specialty board usually does a very good job limiting the supply of providers, ensuring optimal cost of pt acquisition. Sure it will be tough to set up, but with all factors considered, it’s not that much more than the one you’re proposing for psychiatry.
I sometimes check-in with my former co-residents that ended up joining one of those, and they all hate it. Sure you may be able to get some extra cash vs if you worked for a true nonprofit based MH gig. But if your priority is maximizing money thru seeing the maximum number of people, while at the same time also going heavy duty on the business side of things, you’re going to burn out pretty quickly.
If you’re set on this model though and starting med school soon, I suggest going for a surgical subspecialty and applying your plan there. Higher margin per patient, your field is relatively safe from encroachment, and your specialty board usually does a very good job limiting the supply of providers, ensuring optimal cost of pt acquisition. Sure it will be tough to set up, but with all factors considered, it’s not that much more than the one you’re proposing for psychiatry.
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lol dude do you actually have a degree in business? Cause some of this is just straight up nonsensical. Comparing doctor's offices to fast food restaurants I can't even....
McDonalds and Burger King and Taco Bell aren't all near each other because they all WANT to be right next to each other or because there's some advantage to 3 fast food places being in a location or something....who in the world did you hear this from? It's because they all want to drop their footprint in a high traffic area where tons of people drive by and some certain percentage of those people are gonna see a MickeyD's sign and go "hmmm I could really go for a big mac right now". So they all just happen to buy space right off a highway exit or by a strip mall where people shop or along a high traffic road. McDonalds wants to be by the strip mall with the Lowes and Target and Kohls etc etc....not next to a Taco Bell who they have to directly compete with 🤣
Nobody drives past a doctor's office and goes "hmmm I could really go for a psych/neuro/ENT/ophtho appointment right now". You could certainly make the argument that it makes a referral from a PCP office easier but that's an entirely different argument. McDonalds is not referring customers to Burger King hahaha.
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There are many reasons why hospitals have to have business "professionals" in operational roles rather than physicians, too numerous to count here but it's not because most physicians are incapable of getting an MBA. Many physicians aren't interested in running the day to day of a hospital and dealing with all the drama and admin BS. Many physicians are too busy with actual clinical work to even worry about it. Many physicians main goal is (believe it or not) not maximizing income at the expense of all else.
Oh and let's not forget the ACA's effective prohibition on physician owned hospitals that likely led to the intense private equity involvement in this space since 2010.
I'd agree with the above posts that you also just display a fundamental misunderstanding of complex cognitive speciality patients. Unless you're doing the work, you don't understand the amount of burnout that comes from doing multiple intakes every single day for 1+ hour long appointments if you aren't converting a significant amount of those patients into followups
Also yeah, stop saying you've "gone back to school for medicine" when you haven't even started med school yet bud. That'd be like a senior in college saying that to me. You both have the same amount of experience in "medicine" so far.
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“To the ignorant, the wise seem foolish”
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But what if you were the ignorant one?
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That's always the quandary. But let me ask you this…
You wouldn’t ask a doctor to fix your car - right? You wouldn’t trust them. Would you trust an ENT to tailor your suit? Of course not. How about your PCP to cut your hair before your wedding? Still no? Fine, how about trusting the surgeon to tile your bathroom shower? No again!? Why not?
The answer is simple - they are not experts in those topics.
So when the topic is business, why would you defer to a physician over someone with multiple business degrees and decades of real-world experience running companies? Most wouldn’t (unless you’re on SDN of course).
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No quandary here. I'll fill you in; you're the ignorant one in this scenario.
I know plenty of wise people. Not one of them refers to themselves as "wise." Only ignorants think they're wise. Also, people who feel the need to boast about their, quite middling, credentials are usually the ones who have little substance to offer.
To be honest, you sound like a cross between r/iamverysmart and r/im14andthisisdeep. You should check those subreddits out and share your wisdom with them.
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I’m not much of a redditor (it came after my time), but there’s a difference between being “very smart” and just being knowledgeable in one specific area because you have done it for the past two decades. I’m the latter—you’d run circles around me in medicine and probably most other subjects.
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Yup, including how to run a psychiatry practice.
notEinstein
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As we used to tell our clients: “We sell recommendations, not obedience.”
Take what you want, ignore the rest. Even if that that means ignoring all of it.
