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.

 

[PsynofTimes]

How do people in PP deal with cancellations that are within the range of not being charged? Like say a patient cancels 4 days before the appointment. It's not like you can just pop a new patient in there if you're too full to take on a new patient for a course of therapy..?

 

[MCParent]

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.

I never had a shortage of adhd eval referrals and I didn’t rubber stamp things. Put in the paperwork that they’re paying for your time not a dx and also say that to them super clearly. I think the rubber stamp people are mostly looking to pay $50 to some shoddy startup to do an ASRS and a ten minute interview.

 

[MCParent]

How do people in PP deal with cancellations that are within the range of not being charged? Like say a patient cancels 4 days before the appointment. It's not like you can just pop a new patient in there if you're too full to take on a new patient for a course of therapy..?

I’m not clear on the question. If they cancel outside of any penalty you might have and you don’t want to fill the session with a new patient, I guess you’re looking at emails or reading or whatever.

 

[PsynofTimes]

I never had a shortage of adhd eval referrals and I didn’t rubber stamp things. Put in the paperwork that they’re paying for your time not a dx and also say that to them super clearly. I think the rubber stamp people are mostly looking to pay $50 to some shoddy startup to do an ASRS and a ten minute interview.

Thank you for this - I appreciate it. I will make that clear. Have heard some local feedback around someone that's pretty negative and was thinking perhaps it was related to not getting the diagnosis they expected to pay for.

 

[PsynofTimes]

I’m not clear on the question. If they cancel outside of any penalty you might have and you don’t want to fill the session with a new patient, I guess you’re looking at emails or reading or whatever.

Sorry, I meant financially. Like you're pretty full so you can't put in a new patient, but you have patients who cancel outside of the penalty window. Seems like it could result in a big financial hit if it happens a lot.

 

[Doctor Eliza]

Sorry, I meant financially. Like you're pretty full so you can't put in a new patient, but you have patients who cancel outside of the penalty window. Seems like it could result in a big financial hit if it happens a lot.

It isn’t a huge issue in general. It only happens a lot with two of my clients: one has chronic illness and the other it is a clinical issue which I plan to address with her. I chalk it up to the cost of doing business.

Additionally something which works for me but not everyone is that I do not schedule breaks or lunch. If someone cancels it is a much needed free hour.

 

[PsynofTimes]

It isn’t a huge issue in general. It only happens a lot with two of my clients: one has chronic illness and the other it is a clinical issue which I plan to address with her. I chalk it up to the cost of doing business.

Additionally something which works for me but not everyone is that I do not schedule breaks or lunch. If someone cancels it is a much needed free hour.

Thank you - this is good to know. I could do ok without breaks (current VA job has no breaks realistically) but I do have to eat lunch for hypoglycemia reasons. I was hoping to be able to see 8 patients a day though.

 

[Sanman]

Thank you - this is good to know. I could do ok without breaks (current VA job has no breaks realistically) but I do have to eat lunch for hypoglycemia reasons. I was hoping to be able to see 8 patients a day though.

Are you planning to book 8 or see 8? I used to book 9-11 per day at times if I needed a solid 8. Now, I used to work 10am to 10pm back then with a gap in the middle at some point. If you need lunch, block an hour and start a bit earlier or stay later.

 

[MCParent]

It isn’t a huge issue in general. It only happens a lot with two of my clients: one has chronic illness and the other it is a clinical issue which I plan to address with her. I chalk it up to the cost of doing business.

Additionally something which works for me but not everyone is that I do not schedule breaks or lunch. If someone cancels it is a much needed free hour.

Agree. I had/have no cancel fees and I rarely had cancellations or reschedules. Depends somewhat on your population etc though I’m sure.

 

[WisNeuro]

Agree. I had/have no cancel fees and I rarely had cancellations or reschedules. Depends somewhat on your population etc though I’m sure.

Yeah, for my insurance based neuropsych evals, late cancel/no show rate is very small. Long waitlists may have something to do with that. But I'm in low single digit percentages. As for IME/Medicolegal work. I love it when they cancel/no show. My policies on that are very Me friendly.

 

[PsynofTimes]

Are you planning to book 8 or see 8? I used to book 9-11 per day at times if I needed a solid 8. Now, I used to work 10am to 10pm back then with a gap in the middle at some point. If you need lunch, block an hour and start a bit earlier or stay later.

I think I'm still in the VA box and thinking regular business hours. I never thought of maybe doing 12 hour days and booking 10 patients, and having more time off during the week.

 

[Sanman]

I think I'm still in the VA box and thinking regular business hours. I never thought of maybe doing 12 hour days and booking 10 patients, and having more time off during the week.

I would consider your preferred clientele and what hours they want to see you. Working people like evenings and weekends. Parents of kids prefer after 3pm. Folks not working or coming for one time evals usually more amenable to daytime hours.

 

[PsynofTimes]

I would consider your preferred clientele and what hours they want to see you. Working people like evenings and weekends. Parents of kids prefer after 3pm. Folks not working or coming for one time evals usually more amenable to daytime hours.

Thank you for this. I currently have my small practice after hours of the VA and it's full with a wait list, so I'm guessing in my area evening hours would be popular.

 

[hum1]

How do people in PP deal with cancellations that are within the range of not being charged? Like say a patient cancels 4 days before the appointment. It's not like you can just pop a new patient in there if you're too full to take on a new patient for a course of therapy..?

In Europe psychologists and psychotherapists charge for the slot schedule, not for the session. E.g. in the informed consent you inform pts that you are saving that specific date and time for them and therefore will charge them, regardless if they attend the session or not. In the US this is seen as a totalitarian sadistic demand and psychologists feel very guilty about it, and pts do not deal well with this. And moreover, if pt is using insurance, insurance does not pay for missed sessions, so pts have a breakdown because for the first time they will need to pay for a session which up to that date had been a "no financial cost" service.

So most psychologists in the US, knowing that there is in average a 10-20% cancellation rate every week, will over schedule the number of pts. E.g. if you want to see 30 pts a week, you schedule 35, knowing that 5 will probably cancel.

The truth is, is becomes very difficult to accommodate pts missing sessions, because things happen in life, people have emergencies, changes of plans, contingencies, etc. and now you, and your finances, are being impacted by the contingencies of the lives of 30 people. And so pp becomes more uncertain than the stock market. So in the US, therapists protect themselves by writing in the informed consent that if pt misses a certain number of sessions per year, they can be discharged.

 

[PsynofTimes]

In Europe psychologists and psychotherapists charge for the slot schedule, not for the session. E.g. in the informed consent you inform pts that you are saving that specific date and time for them and therefore will charge them, regardless if they attend the session or not. In the US this is seen as a totalitarian sadistic demand and psychologists feel very guilty about it, and pts do not deal well with this. And moreover, if pt is using insurance, insurance does not pay for missed sessions, so pts have a breakdown because for the first time they will need to pay for a session which up to that date had been a "no financial cost" service.

So most psychologists in the US, knowing that there is in average a 10-20% cancellation rate every week, will over schedule the number of pts. E.g. if you want to see 30 pts a week, you schedule 35, knowing that 5 will probably cancel.

The truth is, is becomes very difficult to accommodate pts missing sessions, because things happen in life, people have emergencies, changes of plans, contingencies, etc. and now you, and your finances, are being impacted by the contingencies of the lives of 30 people. And so pp becomes more uncertain than the stock market. So in the US, therapists protect themselves by writing in the informed consent that if pt misses a certain number of sessions per year, they can be discharged.

I think the guilt comes in for me because sometimes I will have to cancel on them, you know? Guess it feels hypocritical to say it's fine for me but not for them. But that could be a "me" issue or maybe something that people go through when they are first figuring themselves out as a therapist that gets paid via session vs. salary.

I appreciate the advice. It makes a lot of sense to build it into the practice and then also have it upfront that if they miss x number, they're discharged.

In the VA, there's never any consequences for not showing up to your appointment, so it's something to get used to also.

 

[WisNeuro]

I think the guilt comes in for me because sometimes I will have to cancel on them, you know? Guess it feels hypocritical to say it's fine for me but not for them. But that could be a "me" issue or maybe something that people go through when they are first figuring themselves out as a therapist that gets paid via session vs. salary.

I appreciate the advice. It makes a lot of sense to build it into the practice and then also have it upfront that if they miss x number, they're discharged.

In the VA, there's never any consequences for not showing up to your appointment, so it's something to get used to also.

All depends on your situation. I very rarely will cancel on my end, and if I do, I will overbook soon to get them in. So, I have very little guilt about my late cancel/no show fees.

 

[medium rare]

How do people in PP deal with cancellations that are within the range of not being charged? Like say a patient cancels 4 days before the appointment. It's not like you can just pop a new patient in there if you're too full to take on a new patient for a course of therapy..?

My late cancelation fee policy is 24 business hours (M-F) notice to avoid being charged. I know many who have 48 hour notices and some with 72. Be clear about your policy from the onset and stick to it. This has reduced the number of no-shows/late cancelations to a minimum and it’s not an issue of impact to any measurable degree in my practice.

Also as you build your practice, keep a cancelation list for those who need/want to be seen sooner. I am almost always able to fill a last minute opening with someone off my cancelation list. My patients know I’m busy and if they want to be seen sooner, they find a way to make the appointment time work.

For new patients, you generally don’t have as much leverage if they cancel but you can always consider having them pre-pay the initial appointment when they schedule. I haven’t done this but know people who do. If a new patient no-shows, I do not reschedule them. If they late cancel, I will reschedule them once but they have to pre-pay at the time they reschedule. This has worked well for me over the years.

 

[hum1]

I think the guilt comes in for me because sometimes I will have to cancel on them, you know? Guess it feels hypocritical to say it's fine for me but not for them. But that could be a "me" issue or maybe something that people go through when they are first figuring themselves out as a therapist that gets paid via session vs. salary.

And there will be times when you will have to cancel sessions because of some of your life's contingencies and your finances will suffer the impact. However, when you also become responsible for all of your patients life's contingencies and suffer financial impact for it, it becomes very complicated. Moreover, you will begin to resent patients who usually miss sessions and are making your practice and your life difficult to manage and to sustain financially and that could impact treatment negatively.

Edit: And about the hypocrisy, your finances are dependent on your clinical work, so there is a difference between you cancelling a session and your patients cancelling a session.

 

[MCParent]

And there will be times when you will have to cancel sessions because of some of your life's contingencies and your finances will suffer the impact. However, when you also become responsible for all of your patients life's contingencies and suffer financial impact for it, it becomes very complicated. Moreover, you will begin to resent patients who usually miss sessions and are making your practice and your life difficult to manage and to sustain financially and that could impact treatment negatively.

Edit: And about the hypocrisy, your finances are dependent on your clinical work, so there is a difference between you cancelling a session and your patients cancelling a session.

I think this is assuming a lot of psychodrama happening.

I didn’t have cancel fees. I rarely had cancellations. Cancellations I had were for reasons like patient was called into a meeting w their F500 company ceo.

I lost maybe $75 (or whatever a cancel fee is) a couple times. What I got was referrals for their friends who could pay my full fee, and who my patients told I was understanding of those kinds of demands.

Caveats: I had/have a small practice. I have LOTS to do other than work, if someone cancels. I come from a school of thought where missing a week and seeing how things go is a great way to test out whether a person needs therapy or has internalized much of the process.

 

[smalltownpsych]

When I worked at a hospital based outpatient therapy practice, we had no cancellation fees but since I had every slot full all the time, I didn’t mind no shows and I made plenty of money. If they had three no shows then we would terminate. Also, we didn’t book out regular appointments for people who were less committed. Current practice is private pay and I have no cancellation fees, but patient’s rarely cancel and I usually have a few open slots. Different models and different strategies. One last thing, people think that it is automatically more profitable to operate outside of insurance but that is not the case, it’s just a different cost benefit analysis and I actually made a little more when I was doing the insurance grind. I definitely worked a hell of a lot harder.

 

[PsynofTimes]

Thanks everyone. I'm moving closer to breaking with the VA every day. I have so many mixed feelings. Right now I'm thinking three days of six patients each for psychotherapy and two days of two assessments each. I don't think I'd be happy doing fully one or fully the other. I also am doing a lot of thinking about how to stay connected to research and other aspects of being a psychologist that are meaningful to me.

 

[PsynofTimes]

Can any non-neuropsychologists who do psychological assessment such as ADHD evals or bariatric evals advise what codes you bill? I'm being told I can't bill the testing codes and that they are only for neuropsychologists.

 

[WisNeuro]

Can any non-neuropsychologists who do psychological assessment such as ADHD evals or bariatric evals advise what codes you bill? I'm being told I can't bill the testing codes and that they are only for neuropsychologists.

Being told by whom?

 

[PsynofTimes]

Being told by whom?

A biller. That I can't bill, say 96136 since I'm not neuro.

 

[WisNeuro]

A biller. That I can't bill, say 96136 since I'm not neuro.

Depends on the payer source.

 

[PsynofTimes]

Depends on the payer source.

I was updated that general psychologists can bill 96130/96131 instead so my worry that the assessment door closed on me is wrong!

 

[WisNeuro]

I was updated that general psychologists can bill 96130/96131 instead so my worry that the assessment door closed on me is wrong!

The assessment codes are based on the services provided.

 

[PsynofTimes]

The assessment codes are based on the services provided.

But there are some assessments that only neuropsychologist can administer, correct (I hope anyway)?

 

[WisNeuro]

But there are some assessments that only neuropsychologist can administer, correct (I hope anyway)?

Depends on how "neuropsychologist" is defined by the publisher of a test, jurisdiction an assessment is completed in, or by the payer.

 

[PsynofTimes]

Depends on how "neuropsychologist" is defined by the publisher of a test, jurisdiction an assessment is completed in, or by the payer.

Yikes. This does not strike me as good for the field.

 

[AcronymAllergy]

Yikes. This does not strike me as good for the field.

I don't necessarily disagree, but it's not really much different then medicine from my understanding, in that the protections are more internal (i.e., providers policing themselves) than external, at least in the sense of regulatory restrictions. Although there can be facility-level restrictions, such as the facility dictating which providers can perform which services via credentialing. You may also not be able to get malpractice coverage or bill for certain services with certain insurers, as has been said.

Technically, a family medicine doctor can perform surgery or TMS or Botox injections, but most don't because: a) they recognize they don't have the training for such; b) malpractice probably wouldn't cover them for it; and c) insurers probably wouldn't reimburse them for it.

 

[PsynofTimes]

I don't necessarily disagree, but it's not really much different then medicine from my understanding, in that the protections are more internal (i.e., providers policing themselves) than external, at least in the sense of regulatory restrictions. Although there can be facility-level restrictions, such as the facility dictating which providers can perform which services via credentialing. You may also not be able to get malpractice coverage or bill for certain services with certain insurers, as has been said.

Technically, a family medicine doctor can perform surgery or TMS or Botox injections, but most don't because: a) they recognize they don't have the training for such; b) malpractice probably wouldn't cover them for it; and c) insurers probably wouldn't reimburse them for it.

I can see that - and also have more concerns about our field's ability to keep the boundaries. But that may be completely anecdotal to my experience vs. based in anything evidential. I'm sure there are family medicine doctors who are out there doing Botox and paralyzing people's faces, sadly.

 

[PsynofTimes]

Another question - for those of you who started your own practice vs. joining one - do you think it was a good call to start your own business? I'm leaning in that direction, but I am a risk-averse VA employee.

 

[Sanman]

Another question - for those of you who started your own practice vs. joining one - do you think it was a good call to start your own business? I'm leaning in that direction, but I am a risk-averse VA employee.

Here is what I learned from my time in a group practice. It will not always matter how good you are at your job, the priority will always be the the group and how you can provide a profit for them.

This may mean that a group has multiple offices, but you only want to work in one location. Well tough, they need you to go to the other location at times because there is an open office. You may not want to work with a certain insurer, but it provides enough volume for all the members of the group. So, tough, you need to accept them. Now some group practices may be more accommodating of employee needs than others. However, these are ultimately businesses that will cater to the needs of the owner and that is not you.

Whether the additional headaches of setting up a practice are worth those trade offs are up to you.

 

[WisNeuro]

Another question - for those of you who started your own practice vs. joining one - do you think it was a good call to start your own business? I'm leaning in that direction, but I am a risk-averse VA employee.

I only regret that I didn't do it sooner.

 

[medium rare]

Another question - for those of you who started your own practice vs. joining one - do you think it was a good call to start your own business? I'm leaning in that direction, but I am a risk-averse VA employee.

I’ve never had second thoughts about starting my own practice. One of the best decisions I’ve made in my life.

 

[Therapist4Chnge]

I’ve never had second thoughts about starting my own practice. One of the best decisions I’ve made in my life.

90% of the time this.

10% wishing I just sold out and stayed in tech bc I would have retired years ago.

 

[smalltownpsych]

No regrets here. Even despite having some recent setbacks that led to some seriously stressful times. My revenue doubled over the 12 months or so and we expanded to meet the new needs but expenses outpaced growth for a variety of reasons. It was a calculated risk and it didn’t pay off so we have to scale back. Painful but hopefully a valuable learning experience. One thing it taught me is that when it comes to a cost benefit analysis, employees overestimate their value and underestimate the costs.