Private Practice Olio

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Been awhile since I updated. Mainly because the business is keeping me very busy. My two interns have completed their degrees and this will help with getting them more cases and justifying their fees. My IOP/aftercare type of program is doing ok and I have four clients in that with one more starting next week and with the new case I am handing it off to my employee so that will be a good thing. Trying to figure out how to pay my newly graduated therapists is the next issue to address.

Last month we generated 25k in revenue and that was with me taking a week vacation. Last year with that vacation, revenue dipped to 16k so progress there. At this point it is clear that we are going to be able to stay afloat and that our business model seems to be working, but we are not exactly going to get rich quick. Some of the reason for that is that I am a better clinician than I am a businessman, but I am okay with that because I think I am good enough at that part and our edge in providing superior clinical services is what I’m selling anyway.
 
smalltownpsych said:
Been awhile since I updated. Mainly because the business is keeping me very busy. My two interns have completed their degrees and this will help with getting them more cases and justifying their fees. My IOP/aftercare type of program is doing ok and I have four clients in that with one more starting next week and with the new case I am handing it off to my employee so that will be a good thing. Trying to figure out how to pay my newly graduated therapists is the next issue to address.

Last month we generated 25k in revenue and that was with me taking a week vacation. Last year with that vacation, revenue dipped to 16k so progress there. At this point it is clear that we are going to be able to stay afloat and that our business model seems to be working, but we are not exactly going to get rich quick. Some of the reason for that is that I am a better clinician than I am a businessman, but I am okay with that because I think I am good enough at that part and our edge in providing superior clinical services is what I’m selling anyway.
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Do your interns also provide superior clinical services?
 
WisNeuro said:
Is there a question behind the question?
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I’m sure you know. But I’ll cal it out more.

It’s an interesting argument regarding whether one’s experience enhances one’s clinical effectiveness. Post doc interns are less experienced. Are they less clinically effective? Or are they more up to date, and thus provide more effective treatment?

It’s like asking if the new interventional radiologist is better at gamma knife because he was trained in it, or saying the established interventional radiologist, who learned gamma knife in less structured settings, is better because he/she has more experience in general. And does that change any malpractice standards? Should patients being treated by residents get a reduction in bills?
 
As with most things in healthcare, the newer post-doc is probably pretty solid w the updated research and interventions, so working with "Horse" cases they likely will do fine to well. Will they do as well with a "Zebra" case...that is where the extra "experience" is likely needed. Just my pure speculation.
 
Therapist4Chnge said:
As with most things in healthcare, the newer post-doc is probably pretty solid w the updated research and interventions, so working with "Horse" cases they likely will do fine to well. Will they do as well with a "Zebra" case...that is where the extra "experience" is likely needed. Just my pure speculation.
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It's a weird thing. Socially, people prefer older providers due to the belief that experience=better. But we also know that cognition declines as we age. And society protects against "age discrimination", that only applies to the older ages and not the younger ages.
 
PsyDr said:
It's a weird thing. Socially, people prefer older providers due to the belief that experience=better. But we also know that cognition declines as we age. And society protects against "age discrimination", that only applies to the older ages and not the younger ages.
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I think that there is a benefit to wisdom as well. While a younger clinician might be more familiar with the latest technique, the wisdom to sometimes leave things alone matters. I learned more of what not to do from early career supervisors/mentors than what to do.
 
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This study found a small but significant decrease in clinical outcomes as a function of therapist experience (more experience, worse outcomes). The effect remained even when controlling for potential confounds such as baseline severity, length of treatment, therapists’ initial level of experience, caseload size, rates of early termination, etc.
 
SikeThatsTheWrongNumber said:
This study found a small but significant decrease in clinical outcomes as a function of therapist experience (more experience, worse outcomes). The effect remained even when controlling for potential confounds such as baseline severity, length of treatment, therapists’ initial level of experience, caseload size, rates of early termination, etc.
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I know people love this study, but people also over interpret it. Only outcome is the OQ-45, and, like everything Wampold, he collapses everything together. This would be stronger with actual random assignment, breaking out diagnoses, measuring more meaningful functional outcomes, and more tightly controlling years of experience. In this study it's a little disingenuous to say that the less experienced therapists did better. These were therapists receiving active supervision for their clinical work, as this study took place at least partially within the context of a training clinic. It's in interesting question, but I don't think this study comes close to answering it, all it does is suggest we need further work done to find support for a hypothesis.
 
WisNeuro said:
I know people love this study, but people also over interpret it. Only outcome is the OQ-45, and, like everything Wampold, he collapses everything together. This would be stronger with actual random assignment, breaking out diagnoses, measuring more meaningful functional outcomes, and more tightly controlling years of experience. In this study it's a little disingenuous to say that the less experienced therapists did better. These were therapists receiving active supervision for their clinical work, as this study took place at least partially within the context of a training clinic. It's in interesting question, but I don't think this study comes close to answering it, all it does is suggest we need further work done to find support for a hypothesis.
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I have not read the details of the study, but I am curious if this is replicated around the world. In the U.S., we are paid to see patients and not for outcome quality. As you get older, this will certainly bias the sample.
 
Sanman said:
I have not read the details of the study, but I am curious if this is replicated around the world. In the U.S., we are paid to see patients and not for outcome quality. As you get older, this will certainly bias the sample.
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A trainee under close supervision, essentially having two therapists on a case, will also bias the results. 🙂
 
Therapist4Chnge said:
As with most things in healthcare, the newer post-doc is probably pretty solid w the updated research and interventions, so working with "Horse" cases they likely will do fine to well. Will they do as well with a "Zebra" case...that is where the extra "experience" is likely needed. Just my pure speculation.
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Yes and you never know when a horse turns into zebra case.
 
MisfitOutlaw said:
In the private practices I see, supervision is minimal. The supervisor therapist is seeing a full load of clients themselves
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How do you know how many hours of supervision is happening in a multitude of private practices? Just out of curiosity. I hear people make certain statements sometimes, and the only way a person would know is if they were embedded within that clinic, for the most part.
 
WisNeuro said:
How do you know how many hours of supervision is happening in a multitude of private practices? Just out of curiosity. I hear people make certain statements sometimes, and the only way a person would know is if they were embedded within that clinic, for the most part.
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The therapists there tell me. They say they sometimes have supervision by phone. And the owner is on vacation alot and unreachable. The therapists are there for their 2000 hours and afraid to rock the boat
 
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MisfitOutlaw said:
The therapists there tell me. They say they sometimes have supervision by phone. And the owner is on vacation alot and unreachable. The therapists are there for their 2000 hours and afraid to rock the boat
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And you hear this about multiple practices? Plural? You're frequently having these kinds of conversations with multiple therapists for some reason?
 
It is not unusual and maybe even typical to have minimal supervision out in the private practice and the community mental health world. This is especially so when comparing to the amount of supervision that psychologists get during our training. The quantity and especially the quality of my own personal supervised experience surpasses anything Ive come across since getting my degree back in 2008.
That being said, part of my model is to provide excellent supervision to my new therapists and have people that appreciate and value me sharing my knowledge and experience. As @WisNeuro said, the patients are getting my support too. Since quite a few of my patients are professionals, they get this and are seeking us out because we are better than the typical and are willing to pay for it. I learned pretty early on that throwing out jargon and not having knowledge of the evidence base is not going to get you very far with a physician or attorney for example.
 
Insurance based practice is totally different animal because the margins are really really tight. No way that I could do what I do if I was running an insurance based practice. I am intentio trying to do things differently and be creative and have that freedom. My question is not could I do more if I had more financial resources, it is more often, given unlimited financial resources for a case, what can we do? The answer to that points to financial barriers not being as much of the obstacle to effective mental health treatment as I used to think.
 
smalltownpsych said:
It is not unusual and maybe even typical to have minimal supervision out in the private practice and the community mental health world. This is especially so when comparing to the amount of supervision that psychologists get during our training. The quantity and especially the quality of my own personal supervised experience surpasses anything Ive come across since getting my degree back in 2008.
That being said, part of my model is to provide excellent supervision to my new therapists and have people that appreciate and value me sharing my knowledge and experience. As @WisNeuro said, the patients are getting my support too. Since quite a few of my patients are professionals, they get this and are seeking us out because we are better than the typical and are willing to pay for it. I learned pretty early on that throwing out jargon and not having knowledge of the evidence base is not going to get you very far with a physician or attorney for example.
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Yes this is just very different from the residency that physicians get as there is a lot of supervision. And under the acgme, many requirements that have to be followed to maintain certification. This is why to me, the "supervision" therapists are getting is very surprising.
 
PsyDr said:
I’m sure you know. But I’ll cal it out more.

It’s an interesting argument regarding whether one’s experience enhances one’s clinical effectiveness. Post doc interns are less experienced. Are they less clinically effective? Or are they more up to date, and thus provide more effective treatment?

It’s like asking if the new interventional radiologist is better at gamma knife because he was trained in it, or saying the established interventional radiologist, who learned gamma knife in less structured settings, is better because he/she has more experience in general. And does that change any malpractice standards? Should patients being treated by residents get a reduction in bills?
Click to expand...
As a resident physician I certainly did not know enough. That's why we had the training, then board certification. I had both an oral and written exam for ABPN board certification. It took me years after that to continue to improve, and I have 150 CME every three years and additional requirements to complete to keep it. Including an exam every ten years. This keeps me up to date on the newer treatments.
 
What are your experiences with the following paid directories? Any of them worth the monthly fee?
  • Mental Health Match
  • Zencare
  • Therapy Den
  • Zocdoc
  • Others?
They're all around a price where one consistent client from each would cover the yearly cost, but I still have this feeling that they aren't worth it in addition to professional referral sources and psychology today. My caseload is about as full as I want it to be at this point, so this is mostly to make sure I can maintain these numbers.
 
Any recommendations for the laptops y'all use in private practice, particularly for telehealth? I have generally had PCs at work and a Mac at home/personal, but will have to decide for myself.
 
thebalmofhurtminds said:
Any recommendations for the laptops y'all use in private practice, particularly for telehealth? I have generally had PCs at work and a Mac at home/personal, but will have to decide for myself.
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I have been shopping and not loving the initial options. Government issued me an HP elitebook, which has been decent. Looking at Lenovo ThinkPad now. I want something with a good Webcam and a built in cover. Considering and external camera setup as well.
 
thebalmofhurtminds said:
Any recommendations for the laptops y'all use in private practice, particularly for telehealth? I have generally had PCs at work and a Mac at home/personal, but will have to decide for myself.
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I'd say you could probably get by pretty well on a Macbook Air. Great built-in camera and the M chips are wicked fast. You can also buy storage and RAM upgrades if you're really concerned about slowdowns, but I've been pretty impressed with the newer Macs as of late.
 
People who have small private practices, any suggestions for what is helping you most with getting new patients currently? Currently I mostly rely on psychologytoday, facebook networking groups, and my state association's listserv. Anything else that I should try?
 
Harry3990 said:
People who have small private practices, any suggestions for what is helping you most with getting new patients currently? Currently I mostly rely on psychologytoday, facebook networking groups, and my state association's listserv. Anything else that I should try?
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Are you insurance or cash pay based? If insurance based, personally reaching out to clinics/providers who would be the most likely to refer out to your services and letting them know you have immediate openings usually works better than any advertising.
 
WisNeuro said:
Are you insurance or cash pay based? If insurance based, personally reaching out to clinics/providers who would be the most likely to refer out to your services and letting them know you have immediate openings usually works better than any advertising.
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More insurance based currently. That is a good idea and something I should definitely do more of.
 
Harry3990 said:
People who have small private practices, any suggestions for what is helping you most with getting new patients currently? Currently I mostly rely on psychologytoday, facebook networking groups, and my state association's listserv. Anything else that I should try?
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1) Other psychologists are NOT a source of referrals. Marketing to other psychologists is like Burger King trying to sell to McDonald's.
2) Identify the largest employer in your geographic area. Identify what insurance they offer. Get paneled with that insurance.
3) Identify your specialized population. Create an "elevator pitch". Find a PCP or psychiatrist with that population. Call them and give them your pitch.
4) If you are religious, do the same with your local pastor/priest/minister/imam/shaman/rabbi/pandit/paatthi/whatever.
5) If you are in peds, pitch to private schools as they do not have formal resources.
6) Some service that contracted with local colleges counseling centers tried to get me to see college kids, a few years ago. Maybe that is a thing.
 
PsyDr said:
1) Other psychologists are NOT a source of referrals. Marketing to other psychologists is like Burger King trying to sell to McDonald's.
2) Identify the largest employer in your geographic area. Identify what insurance they offer. Get paneled with that insurance.
3) Identify your specialized population. Create an "elevator pitch". Find a PCP or psychiatrist with that population. Call them and give them your pitch.
4) If you are religious, do the same with your local pastor/priest/minister/imam/shaman/rabbi/pandit/paatthi/whatever.
5) If you are in peds, pitch to private schools as they do not have formal resources.
6) Some service that contracted with local colleges counseling centers tried to get me to see college kids, a few years ago. Maybe that is a thing.
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All this, and for the love of gosh read your advertising materials as a potential patient. There are so many psych today profiles that start with a stupid quote, and the first sentence or so of your profile is what shows up in your search result entry. A bad photo and “two roads diverged…” showing up in a search result isn’t going to bring in a patient.
 
PsyDr said:
1) Other psychologists are NOT a source of referrals. Marketing to other psychologists is like Burger King trying to sell to McDonald's.
2) Identify the largest employer in your geographic area. Identify what insurance they offer. Get paneled with that insurance.
3) Identify your specialized population. Create an "elevator pitch". Find a PCP or psychiatrist with that population. Call them and give them your pitch.
4) If you are religious, do the same with your local pastor/priest/minister/imam/shaman/rabbi/pandit/paatthi/whatever.
5) If you are in peds, pitch to private schools as they do not have formal resources.
6) Some service that contracted with local colleges counseling centers tried to get me to see college kids, a few years ago. Maybe that is a thing.
Click to expand...

Beg to differ on point #1. I get a lot of referrals from colleagues who are seeing a spouse or parent of someone who wants a psychologist for their family member. Also, when I'm full, I like to have colleagues that I send people to. Also, I have gotten referrals from colleagues who are retiring. Also, I refer to/get referrals from colleagues when the client has a specific specialized need that is a better fit elsewhere. That said, psychologist to psychologist referrals are usually related to actually knowing the psychologist in question and not just cold calling them.

How long have you been in PP? I find that being on insurance panels allows me to spend very little time or effort networking or advertising. My psychology today profile has been set to "not taking new patients" and my voice mail says the same and I still remain full from word of mouth referrals and people who will ask if I can see them anyway. Filling a practice was my biggest concern going out on my own, but it turns out to be a non-issue. I feel confident that I could see double the number of people that I do if there were enough hours in the day.

Good luck!
 
Get in w 2-3+ speciality clinics (e.g. neurology, sleep, chronic pain, etc) and most practices will be busy bc they see hundreds of active patients, so you just need a handful from each clinic/provider and you are set.

You still have to screen all of your referrals bc you don’t want to be a dumping ground for nightmare cases. I refuse to take community psychiatry referrals and referrals w/o prior documentation bc I try to avoid high acuity cases bc my PP isn’t setup to handle BPD, active SI, etc.
 
If you are on insurance panels, then you will fill up. No need to put much effort into marketing. Unless you are doing teleheath which means you’re competing with everyone and have little chance to stand out. Having a nice office and a receptionist was about all I did to start pulling in business and I only take cash. I used to be in sales in my previous life and the biggest mistake colleagues make is burning leads. Extremely rapid response and good appointment settjng skills are key. Don’t say when would you like to come in and start listing a bunch of openings. Say, “I can get you in tomorrow at 2:00 or the following day at 9:00 am which would you prefer?”
Once they are in the door, promptness, professionalism, and rapidly delivering an effective treatment plan are key.
 
Doctor Eliza said:
Beg to differ on point #1. I get a lot of referrals from colleagues who are seeing a spouse or parent of someone who wants a psychologist for their family member. Also, when I'm full, I like to have colleagues that I send people to. Also, I have gotten referrals from colleagues who are retiring. Also, I refer to/get referrals from colleagues when the client has a specific specialized need that is a better fit elsewhere. That said, psychologist to psychologist referrals are usually related to actually knowing the psychologist in question and not just cold calling them.

How long have you been in PP? I find that being on insurance panels allows me to spend very little time or effort networking or advertising. My psychology today profile has been set to "not taking new patients" and my voice mail says the same and I still remain full from word of mouth referrals and people who will ask if I can see them anyway. Filling a practice was my biggest concern going out on my own, but it turns out to be a non-issue. I feel confident that I could see double the number of people that I do if there were enough hours in the day.

Good luck!
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I was doing some contact work for a group for a while last year, but only recently created a psychtoday profile and started getting credentialed through my own practice about a month ago. I’m in network with one insurance plan so far and have three more applications pending. I have a full time hospital job and do some adjuncting, so have had the luxury of really dragging out the process. But I have the time right now to devote more to the private practice, so trying to help it get off the ground.
 
Harry3990 said:
I was doing some contact work for a group for a while last year, but only recently created a psychtoday profile and started getting credentialed through my own practice about a month ago. I’m in network with one insurance plan so far and have three more applications pending. I have a full time hospital job and do some adjuncting, so have had the luxury of really dragging out the process. But I have the time right now to devote more to the private practice, so trying to help it get off the ground.
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IMO, you may be overdoing the credentialing a bit. Most folks in solo practice only need one or two insurance panels to fill up. You can certainly panel more and then get off later. It is just more work.
 
I tend to be a little penny wise and a pound foolish or frugal.

If I started a private, cash pay, practice, could I just use microsoft word for encounter notes? Or do I have to shell out for an EMR.
 
borne_before said:
I tend to be a little penny wise and a pound foolish or frugal.

If I started a private, cash pay, practice, could I just use microsoft word for encounter notes? Or do I have to shell out for an EMR.
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Does your state have any statutes on the books re: healthcare record keeping?
 
WisNeuro said:
Does your state have any statutes on the books re: healthcare record keeping?
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Good question. I have seen board complaints for "failure to keep adequate business records" when there is no documentation.

What do you use?
 
borne_before said:
Good question. I have seen board complaints for "failure to keep adequate business records" when there is no documentation.

What do you use?
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You need to look up the records laws. Our state has an electronic records mandate statute, but exempts certain types of practice, such as my setup.
 
WisNeuro said:
You need to look up the records laws. Our state has an electronic records mandate statute, but exempts certain types of practice, such as my setup.
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There's a psychologist JD dude that I like, if I started up, I'd probably pay him a couple of G's to look at things.
 
borne_before said:
There's a psychologist JD dude that I like, if I started up, I'd probably pay him a couple of G's to look at things.
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You can usually find the statutes pretty easily, and your state HHS site should state things pretty plainly. But, I'd definitely have a lawyer who knows the laws of your state look over your consent forms and any other legal forms you use. You'd also want to know how practices need to register with the state and/or state psych board to do any work.
 
One major hurdle when I think about private practice is location.

I’d want a waiting area—parents need a place to relax while I’m working with their child.

But where to set up? I’ve even considered mapping out all the local child testing psychologists on Google Maps to see where the gaps are.

Do I establish my practice in the wealthier part of the city, where most providers already are?

Or do I set up on the outskirts, where housing is more affordable, young Mormon families are settling, and the area is expanding? Maybe up north, near the new chip plants, where an influx of high-earning engineers will bring more families?

Or would it be better to find something central, near a freeway, bridging the wealthier and growing areas? Perhaps still in the affluent part of town but with easy freeway access?
 
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Does anyone have recommendations for navigating Blue Cross Blue Shield credentialing for out-of-state providers?
Background: I graduated in 2024 and I'm living in Tennessee; I'm not yet licensed in Tennessee as I'm still accumulating post-doc supervised hours to hit licensure requirements. However, I AM licensed in Mississippi, Alabama, and North Dakota, and I am trying to set up a small private practice to offer telehealth services for residents of those states.

UnitedHealthcare had no issue offering me provider contracts, and neither did Aetna and a few other small insurance companies. However, BCBS in each of these states refuses to because I'm not a resident of those states. Even though I have a Registered Agent address for each of those states, they still refuse. They keep saying I must submit claims for BCBS members of their state to the BCBS plan in the state where I live; but when I call BCBS of Tennessee they tell me "we won't reimburse for people who live in a different state as they aren't our members" and they won't contract me anyway since I'm not licensed in Tennessee yet.

Have either of you figured out how to navigate this yet? What did you do to skirt around the "residency" requirements that BCBS seems to have for their state?
 
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