Private practice straight out of residency??

[R Sterling]

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I'm in a unique position that I have interviewed at programs, all of which are within driving distance from my home. Yeah, I still live at home with the parental unit (I'm pretty young). If I get into one of these programs, I will be able to save a lot of my salary because my expenses are very low at this point.

My question is, would it be advantageous to save money and start up a practice right out of residency or get a job with a group for a bit??

I'm planning on practicing where I live, which happens to be a posh county just north of NYC, where a lot of the residents are commuters to the city. I've been trying to quantify how many psychiatrist there are in the area and it seems there aren't very many when compared to other specialties.

How much should I aim to save to be able to start up an office while I build up the practice??

 

[atsai3]

I'm in a unique position that I have interviewed at programs, all of which are within driving distance from my home. Yeah, I still live at home with the parental unit (I'm pretty young). If I get into one of these programs, I will be able to save a lot of my salary because my expenses are very low at this point.

My question is, would it be advantageous to save money and start up a practice right out of residency or get a job with a group for a bit??

I'm planning on practicing where I live, which happens to be a posh county just north of NYC, where a lot of the residents are commuters to the city. I've been trying to quantify how many psychiatrist there are in the area and it seems there aren't very many when compared to other specialties.

How much should I aim to save to be able to start up an office while I build up the practice??

Many residents will work for the state/county part-time (e.g., 20 hrs/week in order to qualify for benefits) while building up their private practice. Once their practices get busy to the point where it's costing them money to work for the state/county, they dump it and go full time private practice.

 

[toothless rufus]

Many residents will work for the state/county part-time (e.g., 20 hrs/week in order to qualify for benefits) while building up their private practice. Once their practices get busy to the point where it's costing them money to work for the state/county, they dump it and go full time private practice.

So you can get full benefits for 20 hrs a week? That's awesome!

 

[nitemagi]

So you can get full benefits for 20 hrs a week? That's awesome!

Depends on the job. 1/2 time may get you 1/2 the benefits or no benefits. I know of few that offer full benefits for half-time.

I am doing Atsai's plan, except I work full-time (off-hours) with 2 full days free for my PP, as well as going through analytic training simultaneously.

Going straight into PP will always take time to build up, so you have to ask what your startup expenses are, how saturated the market is, how long it'll take to get enough patients to be sustainable (# of patients, $/pt, whatever sustainable means for you) - and probably double the estimated time to be safe, and how long are you willing to be poor. The only people I've heard who go straight into PP get onto several insurance panels (applying many months before starting the practice), and even then it takes time to fill. Plus some panels won't accept you if you haven't finished residency.

 

[digitlnoize]

I'm in a unique position that I have interviewed at programs, all of which are within driving distance from my home. Yeah, I still live at home with the parental unit (I'm pretty young). If I get into one of these programs, I will be able to save a lot of my salary because my expenses are very low at this point.

My question is, would it be advantageous to save money and start up a practice right out of residency or get a job with a group for a bit??

I'm planning on practicing where I live, which happens to be a posh county just north of NYC, where a lot of the residents are commuters to the city. I've been trying to quantify how many psychiatrist there are in the area and it seems there aren't very many when compared to other specialties.

How much should I aim to save to be able to start up an office while I build up the practice??

It depends on how you're going to set up your office. At the minimum, you're going to need a space (maybe you can rent some office space for just a day per week to start, then expand as you need more days), utilities, malpractice, and basic supplies (computer, phone, pens, paper, etc). If you're going to do insurance right away you may want an office staff person, unless you're willing to do it yourself, which some people do.

I think the idea of working inpatient in the meantime is a good one. This could be state work, academics, community inpatient, prisons, etc. You start at 40h/wk at these places + 1 day a week private. Once you're one day/week is full, then cut a day at your "full-time" gig, and start booking Day #2 of private practice, and so on.

Your salary from your full time gig *should* be able to cover your expenses from your one day a week office practice without too much hardship, provided you aren't a) getting shafted by your FT job, and b) aren't living large.

As noted, it will also depend on #'s of psychiatrists around you, your specialty if you have one, cash vs insurance, financial situation of the local area, and many other factors...

Good luck!

 

[whopper]

Agree with the above, although you have to take into consideration that the benefits fluctuate depending on the area. In some states, yes 20 hours is fine for benefits, others it isn't. Further if you stay with the state, usually about 25 years (again it depends on the state) you get 1/2 your pay as pension till you die.

And if you strategically maneuver this, the pension is based on the average amount of pay you made in the last few years (1-5 depending on the state as far as I know). Just do full time for the state the last few years and voila, about $90K/year for the rest of your life with full benefits. (Okay that is assuming about 25 years from now things will be similar).

I'm currently doing 32 hours a week for the state, 12-16 hours a week of private practice and about 9 hours a week for the local courts as an expert witness. (I'm actually raking in a lot of money but I am working hard). For me, I rather wouldn't decrease my state job hours because I actually love that job. As for private practice, I'm sticking with it because it makes money but I like it a heck of a lot less than the state job because I got people calling me all the time for frivolous reasons.

In my opinion, part of the frustrations with the PP job are because the way it's set up, but because it's not my own private practice, I either got to leave it and start over, or deal with it for now. As was mentioned above, starting over again is a building process. Your ratio of very sick patients in the beginning is much higher vs the amount of patients that just need to visit you to touch base and get a refill on their meds. For me, after about 6 months, the ratio was sick: less than 50% where as in the beginning it was over 90%. These patients are much more high maintenance and will call you often because they are still having problems that haven't yet stabilized.

The PP I'm at wants to expand my hours, and while I do like them, I also think I might be better off simply starting my own PP or forming one with colleagues that I trust that do good work.

In any case I am going to take up a faculty position because I like to teach, try it out for awhile and if I like it go with it, but if not concentrate on making my own private practice and work for the state again.

 

[sunlioness]

If you're going to do insurance right away you may want an office staff person, unless you're willing to do it yourself, which some people do.

You don't have to hire a full time person for that. There are plenty of billers who will do this for you for a percentage of what they are billing. That's much more affordable than paying someone's full salary. Another thing you might want to think about is whether to hire an answering service, too. Otherwise you're on call 24/7 unless you find someone to share it with. I didn't get a lot of calls when I was solo, but I got some. And it was draining knowing I could be called at any time. But then again, I don't like private practice, whether mine or someone else's.

 

[F0nzie]

Is it mostly academic institutions that have non-compete clause/ covenant not to compete? I'm wondering if full-time positions in under-served areas with loan-repayment (~25k for 2 years) would prevent you from starting up your own private practice on the side 1 day per week.

 

[whopper]

It depends on the institution. Some places are very stringent, others aren't about working at other places. We are all in differing parts of the country and the way this game is played can heavily depend on where you work. The place I'm joining as faculty used to let doctors work liberally outside their institution but rumor has it due to the NY Times article showing some psychiatrists grossly abusing funds from pharm companies, with one of the their own faculty being on the top offenders, they clamped down on that and now it's very difficult to work outside the institution.