Private Practice Olio

[Sanman]

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ok fair-- for my current job, it's a done deal, I'm leaving so I don't think I need to say much more. The problem is the public forum. Maybe it's paranoia but I feel like I could be recognized. I will say I've been in the system a long time, so it's not like I don't know the setting. It's just changed beyond what I can tolerate anymore. I will say that I read the whole VA thread and other stuff on this site and the niche I am in within the VA gets a lot of people posting about how challenging it is.

Don't need details. I am seeing a few major themes overall. Leadership are being asked to be hatchet men. Plenty of programs are being asked to function without staffing, which is impossible. Training directors are having similar issues with staffing. Research is being cancelled generally. Then there are those areas being targeted specifically (LGBTQIA stuff more directly, women's health and MST somewhat less directly). VBA is being overworked to rubber stamp stuff. Suicide Prevention is quietly being changed. And on and on. At the end of the day, this administration needs another market to cannibalize and veterans are it.

My fears about the new job are failure and not being able to get enough referrals. I don't think they are realistic fears. My little practice has been successful beyond what I imagined, and I was quickly full with a wait list and had to turn people away. But I've never done work that wasn't salaried, steady income and it's anxiety provoking to make that change. My VA job has shot my confidence to hell, so I get anxious in sessions in a way I haven't felt before, but the patients don't realize because I am good at what I do (I realize this cognitively, but no longer feel it emotionally).

Are you taking insurance or private pay? Private pay takes time and marketing. Insurance can't find enough breathing bodies to take their rates. If you can take the initial income hit to transition, there will always be insurance-based work. Certainly for any veteran psychologist. Then slowly build up the private pay or higher paying aspects of your work.

The bigger issue with PP is when you get paid. If the practice owner is cutting you a regular check then less worries (but less money). If you are waiting for insurance, processing billing can vary. Medicare is nice because while the rates are mediocre, they pay quickly (within 30 days). Otherwise, best to stash some savings prior to a transition.

 

[PsynofTimes]

Something that might help with some of the anxiety--in the time since I've left employment for PP, I've never really seen a slowdown of postings for jobs for psychologists. The specifics of the jobs may change, but in general, at least right now, if a psychologist needs to find work somewhere, they can probably do so. It might not be a great location or great pay or in a healthy work environment, but the jobs are there.

And as you've experienced, the demand for psychological services in many areas is pretty high. Especially if you take insurance.

I'm guessing you may get a decent AL payout once you leave VA. If so, you could always tuck that away as an emergency fund if you don't need it for any startup costs. And/or set aside some extra money in your business checking account so you can keep paying yourself for a time even if you don't have any income coming in (this is obviously more important if you have employees other than just yourself).

Thank you - that is comforting. It's true that in my area there are always psychologist jobs being posted. They approximate but don't meet my VA salary, but I won't like lose my house or anything. And that's a good point about the AL, I have accumulated a lot. I've also been stashing away all of the practice money since I don't know what my tax situation will be this year, so if I can keep going for a few months longer I should have a decent little fund going to tie me over. I feel like I'm jumping into the deep end of a pool and not sure if I know how to swim or not, even though I've been taking lessons for years.

 

[PsynofTimes]

Don't need details. I am seeing a few major themes overall. Leadership are being asked to be hatchet men. Plenty of programs are being asked to function without staffing, which is impossible. Training directors are having similar issues with staffing. Research is being cancelled generally. Then there are those areas being targeted specifically (LGBTQIA stuff more directly, women's health and MST somewhat less directly). VBA is being overworked to rubber stamp stuff. Suicide Prevention is quietly being changed. And on and on. At the end of the day, this administration needs another market to cannibalize and veterans are it.



Are you taking insurance or private pay? Private pay takes time and marketing. Insurance can't find enough breathing bodies to take their rates. If you can take the initial income hit to transition, there will always be insurance-based work. Certainly for any veteran psychologist. Then slowly build up the private pay or higher paying aspects of your work.

The bigger issue with PP is when you get paid. If the practice owner is cutting you a regular check then less worries (but less money). If you are waiting for insurance, processing billing can vary. Medicare is nice because while the rates are mediocre, they pay quickly (within 30 days). Otherwise, best to stash some savings prior to a transition.

All of those things and more at my current position. And the thing that is making it feel impossible is the impact it's having on the way people treat each other, and it's killing me a little to deal with veterans who don't seem to realize they are cheering on their own demise. I do take insurance so that's good to hear, I'm fully paneled through my current part time practice. They only pay me when insurance pays, so there will definitely be a pause that I have to be able to hurdle.

 

[PsyDr]

My spouse keeps bringing up the fact that there is no sick and vacation, which makes me anxious, but it seems like one could plan to accommodate that.

Step 1: Identify how much sick time your job gives you
Step 2: Identify how much vacation time your job gives you
Step 3: Identify how many CE days/personal days your job gives you. 1
Step 4: Identify how many federal holidays, that fall on a week day you get
Step 5: Identify how many clinical hours your jobs requires you to do per week.
Step 6: Google the CPT codes for your practice (e.g., CPT code for 45 minutes psychotherapy).
Step 7: Google " CMS fee schedule look up tool".
Step 8: Put #6 into #7, multiply that by #5 find your location, find the dollar value of your work per week.
Step 9: Add Steps 1-4. Subtract that from 52.
Step 10: Multiply that by #9 by #8.
Step 11: subtract your operating expenses like rent from #10

Or something like that. It’s pretty simple

 

[AcronymAllergy]

Step 1: Identify how much sick time your job gives you
Step 2: Identify how much vacation time your job gives you
Step 3: Identify how many CE days/personal days your job gives you. 1
Step 4: Identify how many federal holidays, that fall on a week day you get
Step 5: Identify how many clinical hours your jobs requires you to do per week.
Step 6: Google the CPT codes for your practice (e.g., CPT code for 45 minutes psychotherapy).
Step 7: Google " CMS fee schedule look up tool".
Step 8: Put #6 into #7, multiply that by #5 find your location, find the dollar value of your work per week.
Step 9: Add Steps 1-4. Subtract that from 52.
Step 10: Multiply that by #9 by #8.
Step 11: subtract your operating expenses like rent from #10

Or something like that. It’s pretty simple

This. VA gives a decent amount of AL and SL once you're in the second-highest and highest accumulation groups (I think it's maybe ~3 weeks of AL and ~2 weeks of SL?), so I'd guess it works out to somewhere around $30k-40k/year. Making that up in private practice shouldn't be difficult.

 

[PsynofTimes]

Thank you both. It boggles my mind that $30-40K is not difficult to make.
It also makes me think that when they continue to try to make federal employment unbearable, they will take a look at these leave packages and cut them.

 

[WisNeuro]

This. VA gives a decent amount of AL and SL once you're in the second-highest and highest accumulation groups (I think it's maybe ~3 weeks of AL and ~2 weeks of SL?), so I'd guess it works out to somewhere around $30k-40k/year. Making that up in private practice shouldn't be difficult.

I'll make a good chunk of that on my current case alone, long testing day and ~5k pages of records.

 

[Sanman]

Thank you both. It boggles my mind that $30-40K is not difficult to make.
It also makes me think that when they continue to try to make federal employment unbearable, they will take a look at these leave packages and cut them.

At the average national medicare payment and averaging 25-28 pts per week and 48 wks per year, you should bill out $150-200k based on national Medicare rates. You make 70 percent of that currently. You can ball park based on how busy you want to be and if you mostly bill 90834 or 90837. Not sure if you are pulling down anything close to that at the VA. Some of us are and others are not.

 

[PsyDr]

At the average national medicare payment and averaging 25-28 pts per week and 48 wks per year, you should bill out $150-200k based on national Medicare rates. You make 70 percent of that currently. You can ball park based on how busy you want to be and if you mostly bill 90834 or 90837. Not sure if you are pulling down anything close to that at the VA. Some of us are and others are not.

$300/day, 7 days per week is ~$100k/yr

 

[AcronymAllergy]

Thank you both. It boggles my mind that $30-40K is not difficult to make.
It also makes me think that when they continue to try to make federal employment unbearable, they will take a look at these leave packages and cut them.

I should've added--it also depends on how you define "difficult." It takes time and energy, but it's not difficult in the sense of if you take insurance (and/or if you do adult ADHD or ASD evals), your schedule will probably fill as much as you want it to. Feeling up to seeing 12 therapy patients in a day? No problem. Want to work on a Saturday or Sunday to make a little extra (or to take a weekday off)? No problem. Want a day off therapy and instead want to fill it with a few ADHD evals? Oh mercy, really no problem.

The hours you offer your services can matter, particularly for private pay, since people are going to have a tough time getting off work to attend therapy. But at least where I am, given the wait lists for most therapists, I have a feeling most patients would find a way to make it work if you took their insurance and treated what they're dealing with (bonus points if you can see them in-person).

I would add that the clinical work itself has been more rewarding. At least for me, there was often an undercurrent of dread (for lack of a better word), probably related to the underlying, all-present specter of SC. That's no longer there, and I'm also free to decide who/what I want to see.

 

[PsynofTimes]

At the average national medicare payment and averaging 25-28 pts per week and 48 wks per year, you should bill out $150-200k based on national Medicare rates. You make 70 percent of that currently. You can ball park based on how busy you want to be and if you mostly bill 90834 or 90837. Not sure if you are pulling down anything close to that at the VA. Some of us are and others are not.

I'm on the lower side of that range at my current position (gross) and am hoping to stay in that range, and it sounds like it's possible which is fantastic.

 

[PsynofTimes]

I should've added--it also depends on how you define "difficult." It takes time and energy, but it's not difficult in the sense of if you take insurance (and/or if you do adult ADHD or ASD evals), your schedule will probably fill as much as you want it to. Feeling up to seeing 12 therapy patients in a day? No problem. Want to work on a Saturday or Sunday to make a little extra (or to take a weekday off)? No problem. Want a day off therapy and instead want to fill it with a few ADHD evals? Oh mercy, really no problem.

The hours you offer your services can matter, particularly for private pay, since people are going to have a tough time getting off work to attend therapy. But at least where I am, given the wait lists for most therapists, I have a feeling most patients would find a way to make it work if you took their insurance and treated what they're dealing with (bonus points if you can see them in-person).

I would add that the clinical work itself has been more rewarding. At least for me, there was often an undercurrent of dread (for lack of a better word), probably related to the underlying, all-present specter of SC. That's no longer there, and I'm also free to decide who/what I want to see.

So adult ADHD is one of the main areas in which I want to do assessment. I think there's a good market for it, but I worry a bit that the market is skewed toward people who will "rubber stamp" the diagnosis and I am not going to do that, so not sure if once word gets around that people would not want to see me. There is a huge wait list in my area for good therapists and I prefer in person.

I absolutely identify with that dread related to SC. I've had patients that I saw/treated/discharged for various things resurface on my voice mail once they realize, oh, this can be monetized. It's discouraging and exhausting.