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[Sanman]

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I've decided it's best to focus on one thing instead of too many disparate things I don't do as well at. Looking at a combo assessment/therapy practice. Still quite anxious about jumping ship from the VA. Worried about things like consistent referrals, insurance clawbacks, and how to plan for retirement (going to meet with a financial adviser). But the flexibility seems so amazing compared to having to put in 15 minutes of leave when there's a massive snowstorm & I can't get here on time.

1. Definitely agree it is best to focus on one thing at a time if you want to get it right. Even in building a PP, build out the therapy portion, sort your referrals, get your business setup properly. Then focus on adding assessment or additional services.

2. Your leadership seems like a pain. My local timecard people won't even process a 15 min leave.

 

[PsynofTimes]

1. Definitely agree it is best to focus on one thing at a time if you want to get it right. Even in building a PP, build out the therapy portion, sort your referrals, get your business setup properly. Then focus on adding assessment or additional services.

2. Your leadership seems like a pain. My local timecard people won't even process a 15 min leave.

It is a pain. I wish they treated us like actual adults. I mean I get it because some people AREN'T adults, but I get tired of the nickel and diming on patient care and time. They should just have us punch in.

 

[PsynofTimes]

Does anyone have a ballpark number for what a good insurance plan like BCBS will reimburse for ADHD assessment consisting of clinical interview, testing, and report writing? I know that's not an easy question to answer, but wondering if there's any general feedback.

 

[AcronymAllergy]

Does anyone have a ballpark number for what a good insurance plan like BCBS will reimburse for ADHD assessment consisting of clinical interview, testing, and report writing? I know that's not an easy question to answer, but wondering if there's any general feedback.

It's going to be heavily dependent on how long the entire process takes you; almost impossible to answer without that information, unfortunately.

Also, "testing" can be pretty variable. You're not always able to bill for administration time of self-report measures, for example.

 

[WisNeuro]

Does anyone have a ballpark number for what a good insurance plan like BCBS will reimburse for ADHD assessment consisting of clinical interview, testing, and report writing? I know that's not an easy question to answer, but wondering if there's any general feedback.

Need to check your local BCBS policy, ours is fairly limiting for ADHD evals.

 

[PsyDr]

I've decided it's best to focus on one thing instead of too many disparate things I don't do as well at. Looking at a combo assessment/therapy practice. Still quite anxious about jumping ship from the VA. Worried about things like consistent referrals, insurance clawbacks, and how to plan for retirement (going to meet with a financial adviser). But the flexibility seems so amazing compared to having to put in 15 minutes of leave when there's a massive snowstorm & I can't get here on time.

1) I think this approach is wise. However, you shouldn't avoid things due to a lack of mastery. You achieve mastery by repetitively doing a task.

2) While waiting is wise, I'd point out that you're focusing on VERY infrequent things.
a. Referrals: How often have you heard of a therapist without a wait list? That should tell you something about referrals.
b. Insurance clawbacks: I've had exactly two instances, ever.

3) I would highly recommend planning your retirement using Firecalc. Input your stuff. Google terms you don't know. Keep playing with it until you can make sense of the subject matter. There are other retirement planning things, but few better.

 

[PsynofTimes]

1) I think this approach is wise. However, you shouldn't avoid things due to a lack of mastery. You achieve mastery by repetitively doing a task.

2) While waiting is wise, I'd point out that you're focusing on VERY infrequent things.
a. Referrals: How often have you heard of a therapist without a wait list? That should tell you something about referrals.
b. Insurance clawbacks: I've had exactly two instances, ever.

3) I would highly recommend planning your retirement using Firecalc. Input your stuff. Google terms you don't know. Keep playing with it until you can make sense of the subject matter. There are other retirement planning things, but few better.

Thank you for this advice. I have so much anxiety about leaving the certainty behind, so it's reassuring to hear that there aren't too many insurance clawbacks. Therapy seems to be in high demand, and I'm a good therapist, so I think I'll be ok, but it does take some time to build & then wait for insurance reimbursements. Thank you for the advice on Firecalc.

 

[PsynofTimes]

It does appear that insurance is fairly limited on what it covers for ADHD evals unless there is another diagnosis. Seems odd. If the person only has ADHD, which I understand is rare but not impossible, the insurance won't pay based on the diagnosis? Seems crazy.

 

[WisNeuro]

It does appear that insurance is fairly limited on what it covers for ADHD evals unless there is another diagnosis. Seems odd. If the person only has ADHD, which I understand is rare but not impossible, the insurance won't pay based on the diagnosis? Seems crazy.

Hasn't been my experience that they won't pay, rather they won't pay for neuropsych testing codes and won't pay for a an unnecessary number of psych testing codes

 

[PsynofTimes]

Hasn't been my experience that they won't pay, rather they won't pay for neuropsych testing codes and won't pay for a an unnecessary number of psych testing codes

Oh ok thank you. I think the biller is confused between psych testing and neuropsych testing.

 

[WisNeuro]

Oh ok thank you. I think the biller is confused between psych testing and neuropsych testing.

They commonly are. If this is something you plan on doing regularly, you should definitely pull the insurer's psych/neuropsych testing policies and know them well. It will potentially save you a lot of time and money on the back end.

 

[PsynofTimes]

They commonly are. If this is something you plan on doing regularly, you should definitely pull the insurer's psych/neuropsych testing policies and know them well. It will potentially save you a lot of time and money on the back end.

Thank you for this advice!

 

[PsyDr]

It does appear that insurance is fairly limited on what it covers for ADHD evals unless there is another diagnosis. Seems odd. If the person only has ADHD, which I understand is rare but not impossible, the insurance won't pay based on the diagnosis? Seems crazy.

1) That is HIGHLY dependent on the specific insurance policy. There is zero coherence between plans, even under the same insurance company. Medicare might pay for all testing. "ACME Bronze Plus of Random State" might not pay for any psych testing for conditions they don't cover, but "ACME Emerald Plus of Random State" might only pay for 2 units of testing. Reading the provider handbook takes some time, but it is pretty easy to do. Some insurance companies require you to take all their policies, but you can schedule limited availability for that policy.

2) Your NPI taxonomy might affect your ability to get reimbursed. Make sure that your NPI taxonomy matches the other testers in your area.

3) Money: I would HIGHLY recommend that you keep significant cash reserves in your business account. Let's say you net $150k your first year, and you pay yourself $90k. With that kind of backing, you can easily withstand the highs and lows of practice. If it builds up, there are ways to pay yourself a dividend.

 

[AcronymAllergy]

1) That is HIGHLY dependent on the specific insurance policy. There is zero coherence between plans, even under the same insurance company. Medicare might pay for all testing. "ACME Bronze Plus of Random State" might not pay for any psych testing for conditions they don't cover, but "ACME Emerald Plus of Random State" might only pay for 2 units of testing. Reading the provider handbook takes some time, but it is pretty easy to do. Some insurance companies require you to take all their policies, but you can schedule limited availability for that policy.

2) Your NPI taxonomy might affect your ability to get reimbursed. Make sure that your NPI taxonomy matches the other testers in your area.

3) Money: I would HIGHLY recommend that you keep significant cash reserves in your business account. Let's say you net $150k your first year, and you pay yourself $90k. With that kind of backing, you can easily withstand the highs and lows of practice. If it builds up, there are ways to pay yourself a dividend.

Agreed, and doubly so if you have any employees. You could also look into opening a business line of credit "just in case," but having the case reserves on hand is a safer bet. It could also be tough to open the line of credit unless you have a pre-existing relationship with the bank and/or until you have some business credit or earnings history.

 

[PsynofTimes]

1) That is HIGHLY dependent on the specific insurance policy. There is zero coherence between plans, even under the same insurance company. Medicare might pay for all testing. "ACME Bronze Plus of Random State" might not pay for any psych testing for conditions they don't cover, but "ACME Emerald Plus of Random State" might only pay for 2 units of testing. Reading the provider handbook takes some time, but it is pretty easy to do. Some insurance companies require you to take all their policies, but you can schedule limited availability for that policy.

2) Your NPI taxonomy might affect your ability to get reimbursed. Make sure that your NPI taxonomy matches the other testers in your area.

3) Money: I would HIGHLY recommend that you keep significant cash reserves in your business account. Let's say you net $150k your first year, and you pay yourself $90k. With that kind of backing, you can easily withstand the highs and lows of practice. If it builds up, there are ways to pay yourself a dividend.

Thank you for this! I am looking into getting the provider handbooks now for all the insurances that I will take and make myself a spreadsheet of what they cover. I checked my taxonomy and that seems to be in line with other people's in the area. and good to know about the reserves!

 

[PsynofTimes]

Agreed, and doubly so if you have any employees. You could also look into opening a business line of credit "just in case," but having the case reserves on hand is a safer bet. It could also be tough to open the line of credit unless you have a pre-existing relationship with the bank and/or until you have some business credit or earnings history.

No employees just yet... hopefully I can just get the cash reserves.

 

[WisNeuro]

Agreed, and doubly so if you have any employees. You could also look into opening a business line of credit "just in case," but having the case reserves on hand is a safer bet. It could also be tough to open the line of credit unless you have a pre-existing relationship with the bank and/or until you have some business credit or earnings history.

Third this. At any given time, I keep enough cash in my business accounts to pay my salary and overhead for 4+ months. Also, keep my personal "liquid emergency funds" going at a good 6+ months. And then some semi-liquidable investments that can be pulled from in case of an extended emergency. Contingency plans are good to have once you can fund them. Though, not taking out an absurd amount of loans helps with making this a reality sooner rather than later.

 

[PsynofTimes]

Third this. At any given time, I keep enough cash in my business accounts to pay my salary and overhead for 4+ months. Also, keep my personal "liquid emergency funds" going at a good 6+ months. And then some semi-liquidable investments that can be pulled from in case of an extended emergency. Contingency plans are good to have once you can fund them. Though, not taking out an absurd amount of loans helps with making this a reality sooner rather than later.

Thank you - I think I can do this with hopefully not taking out any loans.

 

[WisNeuro]

Thank you - I think I can do this with hopefully not taking out any loans.

I'd hope not at this point, I was more referring to those who took out an unwise level of loans for their degrees.

 

[PsynofTimes]

I'd hope not at this point, I was more referring to those who took out an unwise level of loans for their degrees.

oh, ok. Thankfully I'm not in that boat either.

 

[PsynofTimes]

How did everyone know when it was ok to pull the trigger and leave an agency? I have regular referrals coming in for individual therapy and with some very minimal marketing seem to be getting a lot of interest for evals... but I'm nervous. Especially since our brilliant president seems to be driving our economy directly into a trash heap.

 

[Doctor Eliza]

At a certain point you just have to take the leap. If you wait until you feel ready, you’ll never do it. The thing that gave me a little shove to do it was doing my taxes and realizing my income for that year was the same as the year before and the year before. I recognized I’d never make more until I left the group practice.

My only regret about going into solo PP was that I didn’t do it sooner!

 

[AcronymAllergy]

At a certain point you just have to take the leap. If you wait until you feel ready, you’ll never do it. The thing that gave me a little shove to do it was doing my taxes and realizing my income for that year was the same as the year before and the year before. I recognized I’d never make more until I left the group practice.

My only regret about going into solo PP was that I didn’t do it sooner!

Agreed; if you're waiting for the perfect time, or the time when it feels like there will be absolutely no risk or uncertainty, it'll never happen. But that's the same for just about any job change, really.

In my case, the deciding factor wasn't the money per se (although that factored in); it was a combination of feeling infantilized by healthcare systems and management, and realizing after looking through listserv posts that even if it failed completely, there'd be a hospital-based job out there somewhere for me to go back to, if needed.

 

[R. Matey]

In my case, the deciding factor wasn't the money per se (although that factored in); it was a combination of feeling infantilized by healthcare systems and management, and realizing after looking through listserv posts that even if it failed completely, there'd be a hospital-based job out there somewhere for me to go back to, if needed.

We've had some people join us from PP recently, which has kinda been discouraging to my low-key plan of leaving for PP. No idea if that was due to market forces and/or being bad at business. The comments upthread about having some money saved to fall back on are well-taken though.

 

[AcronymAllergy]

We've had some people join us from PP recently, which has kinda been discouraging to my low-key plan of leaving for PP. No idea if that due was market forces and/or being bad at business. The comments upthread about having some money saved to fall back on are well-taken though.

I can see the appeal of stability in the current sociopolitical climate, and having employer-sponsored health insurance is always nice. Although by that same measure, I definitely haven't seen a slowdown in demand for services.

I could certainly see more and more psychologists (and other MH professionals) moving toward a fully self-pay business model given the ongoing clusterf--- with insurance reimbursement. But I think a self-pay model maybe turns some psychologists off from PP and/or they're less comfortable with it

 

[Sanman]

We've had some people join us from PP recently, which has kinda been discouraging to my low-key plan of leaving for PP. No idea if that was due to market forces and/or being bad at business. The comments upthread about having some money saved to fall back on are well-taken though.

It could be neither. While PP is great in many ways, not everyone is cash pay or forensics making a killing. Plenty of folks breaking even compared to the new special salary rates the VA pays. Personally, I am not sure I would make significantly more than I do now. It is just that there may be fewer headaches (or not).

There is also the non monetary preferences. The isolation of solo PP is not for everyone and group PP may not pay as well.

 

[R. Matey]

I could certainly see more and more psychologists (and other MH professionals) moving toward a fully self-pay business model given the ongoing clusterf--- with insurance reimbursement. But I think a self-pay model maybe turns some psychologists off from PP and/or they're less comfortable with it

This would probably be the way to go if I were to do it. I have f*** you money on top of emergency saving in semi-liquid assets already (much easy to build when you don't have insane amounts of student loan debt), which I was imagining would functioning as a PP start up fund if things go well. I like where I am well-enough but I'm open to other opportunities as well. The more I look around though, solo PP seems like the best of all options in terms of time, money, and freedom. I really do miss the research side of things, but I got to a point in my career that it really didn't seem it was going to pay as well as straight clinical plus side consulting.

There is also the non monetary preferences. The isolation of solo PP is not for everyone and group PP may not pay as well.

Yeah, and to your point, our org pays a pretty competitive salary (comparable to the local VA adjusted for a mid-to-high CoL) and we have pretty good benefits so I can see the appeal to folks tired of slinging it out in PP for ~$110k without benefits. Personally, I don't really mind working alone. I'm an introvert by nature and psychologists are a miserable group of people to interact with on a daily basis (present company excluded 🙂).

 

[Sanman]

This would probably be the way to go if I were to do it. I have f*** you money on top of emergency saving in semi-liquid assets already (much easy to build when you don't have insane amounts of student loan debt), which I was imagining would functioning as a PP start up fund if things go well. I like where I am well-enough but I'm open to other opportunities as well. The more I look around though, solo PP seems like the best of all options in terms of time, money, and freedom. I really do miss the research side of things, but I got to a point in my career that it really didn't seem it was going to pay as well as straight clinical plus side consulting.



Yeah, and to your point, our org pays a pretty competitive salary (comparable to the local VA adjusted for a mid-to-high CoL) and we have pretty good benefits so I can see the appeal to folks tired of slinging it out in PP for ~$110k without benefits. Personally, I don't really mind working alone. I'm an introvert by nature and psychologists are a miserable group of people to interact with on a daily basis (present company excluded 🙂).

IMO, the slush fund on top of emergency savings is a very good idea and one that I have in place as well. Definitely have some runway when starting any business.

$110k with no benefits is doing something wrong as a psychologist or not working that hard. As a midlevel, I could see it. I would need $200k or more to make PP worth it. If I did need to find a new job, I am much more likely to be returning to the office currently. That is not to say it in undoable, but less than that is a lot of work for more of a lateral move.

 

[WisNeuro]

IMO, the slush fund on top of emergency savings is a very good idea and one that I have in place as well. Definitely have some runway when starting any business.

$110k with no benefits is doing something wrong as a psychologist or not working that hard. As a midlevel, I could see it. I would need $200k or more to make PP worth it. If I did need to find a new job, I am much more likely to be returning to the office currently. That is not to say it in undoable, but less than that is a lot of work for more of a lateral move.

Yes, even with purely insurance based clinical work, this would be pretty low if you were anywhere near FT.

 

[R. Matey]

Yes, even with purely insurance based clinical work, this would be pretty low if you were anywhere near FT.

That's a bit of an estimate from the bits-and-pieces I've heard. That figure does track with what I've heard LPCs throw around. Those who make more are group practice owners.

 

[WisNeuro]

That's a bit of an estimate from the bits-and-pieces I've heard. That figure does track with what I've heard LPCs throw around. Those who make more are group practice owners.

This would be odd for psychologists. Therapy codes, per hour, reimburse more than the hourly average for neuropsych assessment. And I can blow that number out of the water even if all I saw was medicare patients.

 

[R. Matey]

This would be odd for psychologists. Therapy codes, per hour, reimburse more than the hourly average for neuropsych assessment. And I can blow that number out of the water even if all I saw was medicare patients.

Not gonna get into specifics on a public forum, but as I said, it seemed to be from a combination of bad business practices and market forces.

 

[WisNeuro]

Not gonna get into specifics on a public forum, but as I said, it seemed to be from a combination of bad business practices and market forces.

Fair, but sounds like more of the former. Otherwise, it'd have to be a saturated area. Waitlists for doctoral level providers for therapy who take insurance is pretty high here. Somewhat saturated with midlevels, but my doctoral referral list is definitely booked.

 

[Sanman]

That's a bit of an estimate from the bits-and-pieces I've heard. That figure does track with what I've heard LPCs throw around. Those who make more are group practice owners.

LPCs generally make 25% less than us even on medicare/insurance contracts other than, I think, Cigna/Bravo. Group practice is different with ownership taking a cut. Solo ownership I would expect at least $125-150k even in lower paying regions. Plenty of folks making in that range as an employee though.

 

[AcronymAllergy]

Just some very, very quick-and-dirty math for folks looking at what they're paid vs. what they're billing:

If we assume you're doing outpatient neuropsych and seeing 5 patients/week (very manageable solo) at $800 per, working 47 weeks/year (accounting for holidays, time off, etc.), you're billing $188k/year. Knock off $20k for no-shows and whatever else, and you're at $168k/year. That's obviously before taxes, retirement, business expenses, etc., but at that workload, it isn't too shabby for somewhat paltry reimbursement rates.

If you hire 1 or 2 testers, those numbers can begin increasing exponentially. Or if you get better insurance rates or want to do private pay and bill $1k per, that adds up quickly (i.e., the above bumps up to $235k gross).

For therapy, I'm completely guessing, but if assuming $150/hour, you need to see 27 patients/week to hit numbers similar to the first example above (i.e., $190k gross). That doesn't sound horrible.

But this all also assumes you're filling your schedule completely, which can take some time if you aren't on any insurance panels.

IME, the biggest things that seem to draw people to PP are: freedom/autonomy (administratively, clinically, etc.), having a natural inclination toward being a business owner, and/or appreciating the concept of more work = more pay.

 

[Sanman]

Just some very, very quick-and-dirty math for folks looking at what they're paid vs. what they're billing:

If we assume you're doing outpatient neuropsych and seeing 5 patients/week (very manageable solo) at $800 per, working 47 weeks/year (accounting for holidays, time off, etc.), you're billing $188k/year. Knock off $20k for no-shows and whatever else, and you're at $168k/year. That's obviously before taxes, retirement, business expenses, etc., but at that workload, it isn't too shabby for somewhat paltry reimbursement rates.

If you hire 1 or 2 testers, those numbers can begin increasing exponentially. Or if you get better insurance rates or want to do private pay and bill $1k per, that adds up quickly (i.e., the above bumps up to $235k gross).

For therapy, I'm completely guessing, but if assuming $150/hour, you need to see 27 patients/week to hit numbers similar to the first example above (i.e., $190k gross). That doesn't sound horrible.

But this all also assumes you're filling your schedule completely, which can take some time if you aren't on any insurance panels.

IME, the biggest things that seem to draw people to PP are: freedom/autonomy (administratively, clinically, etc.), having a natural inclination toward being a business owner, and/or appreciating the concept of more work = more pay.

Looking at medicare National payment amounts:
90834 - $114
90837 - $167

So call it $140.5 billing 50/50 puts you at $178k for 27 patients. Call it $160k after basic expenses.

Now, VA pays about 70-75% of my family health insurance premium. That about $20k.

Take $20k off that $160-168k and you may not really be making more going solo.

However, this is only with basic insurance reimbursement.

 

[WisNeuro]

Looking at medicare National payment amounts:
90834 - $114
90837 - $167

So call it $140.5 billing 50/50 puts you at $178k for 27 patients. Call it $160k after basic expenses.

Now, VA pays about 70-75% of my family health insurance premium. That about $20k.

Take $20k off that $160-168k and you may not really be making more going solo.

However, this is only with basic insurance reimbursement.

Most of my non-Medicare payers are a good deal above this. When they send me my fee schedules, I get the therapy figures as well.

 

[Sanman]

Most of my non-Medicare payers are a good deal above this. When they send me my fee schedules, I get the therapy figures as well.

I often wonder how much above it they really are with the 90834 vs 90837 audit games. Whereas Medicare is pretty straightforward with the billing.

 

[WisNeuro]

I often wonder how much above it they really are with the 90834 vs 90837 audit games. Whereas Medicare is pretty straightforward with the billing.

I'll quote one payer, of which I have never been audited, and know of no issues with it from colleagues or back when I was on the payer committee in our state org. 167 and 246.

 

[Sanman]

I'll quote one payer, of which I have never been audited, and know of no issues with it from colleagues or back when I was on the payer committee in our state org. 167 and 246.

So if they only allow 90834 same as medicare 90837. If they are allowing 90837, then significantly more.

 

[WisNeuro]

So if they only allow 90834 same as medicare 90837. If they are allowing 90837, then significantly more.

I have not heard about this particular payer having issues with 837. BCBS is the one here that constantly audits and makes everyone's life a PITA. Which is why many of us have de-paneled with them.

 

[Sanman]

I have not heard about this particular payer having issues with 837. BCBS is the one here that constantly audits and makes everyone's life a PITA. Which is why many of us have de-paneled with them.

BCBS is the most recent one I have heard about. UNH used to be one of the bigger auditors prevously and BCBS used to be decent. It all changes over time.

 

[WisNeuro]

BCBS is the most recent one I have heard about. UNH used to be one of the bigger auditors prevously and BCBS used to be decent. It all changes over time.

Been pretty consistent here over a decade. BCBS has been a consistent problem. Cigna is off and on, but there compensation lags anyway, so most of my colleagues don't take them anyway. The others here have been pretty good.

 

[Doctor Eliza]

Regional differences can make a big difference in compensation. The numbers you are talking seem high to me. My area seems particularly low. Medicare is definitely one of my best payers (I only do therapy). A grad school friend who lives 4 hrs north of me in a smaller metro area with a similar cost of living makes like $30 more per session with the same insurer. It adds up fast.

So my next PP goal is to start dropping low paying insurance panels and moving toward a more cash pay oriented practice. On the positive side, taking insurance keeps me insanely full right now. I consistently book 40 client hours per week.

If you are starting from scratch, don’t get on too many panels. Harder to get off than to never get on!

Best,
Dr. E

 

[Sanman]

Been pretty consistent here over a decade. BCBS has been a consistent problem. Cigna is off and on, but there compensation lags anyway, so most of my colleagues don't take them anyway. The others here have been pretty good.

Make me feel old why don't you. Left group practice for VA about a decade ago. Mainly due to UNH shenanigans at the time.

 

[AcronymAllergy]

Looking at medicare National payment amounts:
90834 - $114
90837 - $167

So call it $140.5 billing 50/50 puts you at $178k for 27 patients. Call it $160k after basic expenses.

Now, VA pays about 70-75% of my family health insurance premium. That about $20k.

Take $20k off that $160-168k and you may not really be making more going solo.

However, this is only with basic insurance reimbursement.

Indeed. Although I would add that as a business owner, there are tax breaks associated with you and/or your company paying your healthcare premiums. So it's not an entirely 1:1 comparison. Or if you're able to switch to a spouse's employer plan, that can make a difference.

But ultimately yes, if a psychologist's plan for PP is to do 100% insurance-based clinical work at a similar clip as in their employed position, depending on the employer and insurers where they practice, PP may not offer much of a raise. So then you're deciding if the other trade offs and benefits are worth it for you. For me personally, they probably would be. For others, maybe not.

 

[WisNeuro]

Indeed. Although I would add that as a business owner, there are tax breaks associated with you and/or your company paying your healthcare premiums. So it's not an entirely 1:1 comparison. Or if you're able to switch to a spouse's employer plan, that can make a difference.

But ultimately yes, if a psychologist's plan for PP is to do 100% insurance-based clinical work at a similar clip as in their employed position, depending on the employer and insurers where they practice, PP may not offer much of a raise. So then you're deciding if the other trade offs and benefits are worth it for you. For me personally, they probably would be. For others, maybe not.

Agree, people definitely do think about the tax breaks, or the extra opportunities to shield revenue from taxes when they are comparing the two. Also, I see a lot of people dismiss PP revenue as "that's before taxes!" as if their W2 paychecks don't have taxes. Either way, if people are thinking about the two options and don't have a solid grasp on taxes and other business stuff, they'd probably be better off in consulting with a financial specialist who has knowledge in their area about what this could look like so they can compare some real numbers. You also bring up a good point, even if I don't make a lot more than I did in a hospital job and was just breaking even, I'd still go PP if just for the significant flexibility that I have. It's been huge with kids and other non-work responsibilities.

 

[Sanman]

Indeed. Although I would add that as a business owner, there are tax breaks associated with you and/or your company paying your healthcare premiums. So it's not an entirely 1:1 comparison. Or if you're able to switch to a spouse's employer plan, that can make a difference.

But ultimately yes, if a psychologist's plan for PP is to do 100% insurance-based clinical work at a similar clip as in their employed position, depending on the employer and insurers where they practice, PP may not offer much of a raise. So then you're deciding if the other trade offs and benefits are worth it for you. For me personally, they probably would be. For others, maybe not.

Agreed. I am simply pushing back on the idea that PP automatically means a huge raise. Now, it would have been more clear cut pre-pandemic. However, with some of the recent pay increases employment has been more competitive in some areas. I do agree that lifestyle is a huge bonus factor. I do miss being able to hit the gym mid day if I had a break in patients. Though, I am appreciating paid sick leave with all the illnesses due kid germs.

 

[WisNeuro]

Agreed. I am simply pushing back on the idea that PP automatically means a huge raise. Now, it would have been more clear cut pre-pandemic. However, with some of the recent pay increases employment has been more competitive in some areas. I do agree that lifestyle is a huge bonus factor. I do miss being able to hot the gym mid day if I had a break in patients. Though, I am appreciating paid sick leave with all the illnesses due kid germs.

That's fair, and those of us in forensic work have been pretty up front that this is a revenue multiplier that most PP people will not pursue, nor should they, it's not for everyone. Though, we honestly appreciate those who do it badly 🙂 But, it is pretty easy to pretty much at least match most people's net compensation, with fairly minimal work above and beyond what they already do. And, if you want to offload some of the admin stuff, there are ways to do that relatively cheaply.

 

[PsynofTimes]

Agreed; if you're waiting for the perfect time, or the time when it feels like there will be absolutely no risk or uncertainty, it'll never happen. But that's the same for just about any job change, really.

In my case, the deciding factor wasn't the money per se (although that factored in); it was a combination of feeling infantilized by healthcare systems and management, and realizing after looking through listserv posts that even if it failed completely, there'd be a hospital-based job out there somewhere for me to go back to, if needed.

Money is a source of anxiety because my VA salary is quite good overall. But I absolutely identify with everything else you said. I'm tired of being infantilized, tired of the absolute lack of flexibility. And I'm horrifically tired of the VA climate right now.