Private Practice vs Public Sector in Neuropsychology

[marzzz98]

Hello everyone,

In terms of income and financial stability, is it better to work in the public sector (hospitals/clinics) or private practice as a neuropsychologist? For reference I live in California.

Thank you.

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[PsyDr]

Income and Stability are competing concepts.

If you are an employee: you are giving away a percentage of your income, to guarantee a paycheck, regardless of reduced income or increased costs.

If you are self employed: You take home 100% of the profits. But you assume the risks of reduced income or increased costs (eg., business getting slow, reimbursement going down, not making money whilst on vacation, your office or employee costs going up, etc).

What’s better? That depends on your risk tolerance and your position in life.

 

[AcronymAllergy]

Second everything PsyDr has said. Broadly speaking, for stability/having a steady paycheck, employed work is generally going to be the winner. For total income/compensation, private practice will usually win out. California has its own interesting laws for certain areas of neuropsychological practice, such as forensic work. It also, I imagine, has many saturated markets due to the number of people who've trained there (e.g., many larger for-profit schools in addition to numerous, more traditional public and private universities) and/or who want to live there, which can affect the job market.

 

[WisNeuro]

Stability is pretty easy to come by in the clinical world for neuropsychology. If you take insurance, all you have to do is let referral sources know you have opening sand you'll have a months long waitlist in no time. I'm getting to the point that I may stop scheduling patients for a month or two as I do not like booking out too far in advance to maintain schedule flexibility.

 

[AcronymAllergy]

Stability is pretty easy to come by in the clinical world for neuropsychology. If you take insurance, all you have to do is let referral sources know you have opening sand you'll have a months long waitlist in no time. I'm getting to the point that I may stop scheduling patients for a month or two as I do not like booking out too far in advance to maintain schedule flexibility.

I was going to say something similar. Although for plug-and-play stability and for someone who just wants to show up to work, do some work, and go home without thinking more about it, an employed position is still "better" than private practice, IMO. You get paid for no-shows and/or other days when you don't have any work (e.g., sick days), there's not the possibility of lulls in referrals significantly impacting your income, you don't have to do all the things required in managing your business (e.g., find tax and business law folks, keep your books, find insurance coverage, etc.).

On the flip side, the income upside is almost always going to be higher when you're self-employed. There's also much more flexibility in just about all respects. Do or don't want to see certain types of cases? No problem. Want to change your report style? No problem. Suddenly want to offer a new group starting next week? No problem. Need to take the afternoon off to hang out at the beach? No problem. Want to hire someone to handle all the administrative stuff you hate doing? Have at it.

 

[WisNeuro]

I was going to say something similar. Although for plug-and-play stability and for someone who just wants to show up to work, do some work, and go home without thinking more about it, an employed position is still "better" than private practice, IMO. You get paid for no-shows and/or other days when you don't have any work (e.g., sick days), there's not the possibility of lulls in referrals significantly impacting your income, you don't have to do all the things required in managing your business (e.g., find tax and business law folks, keep your books, find insurance coverage, etc.).

On the flip side, the income upside is almost always going to be higher when you're self-employed. There's also much more flexibility in just about all respects. Do or don't want to see certain types of cases? No problem. Want to change your report style? No problem. Suddenly want to offer a new group starting next week? No problem. Need to take the afternoon off to hang out at the beach? No problem. Want to hire someone to handle all the administrative stuff you hate doing? Have at it.

For ease of practice, I agree. Employed in an organization is good if you really hate the admin stuff. Though, in my experience, the admin stuff is pretty minimal. And, if you want, you can hire someone to do it pretty cheaply. As for no-shows/late cancellations, they've been very rare in my clinic. The prospect of waiting an additional 6+ months to be seen usually makes most people keep those appointments.

 

[AcronymAllergy]

For ease of practice, I agree. Employed in an organization is good if you really hate the admin stuff. Though, in my experience, the admin stuff is pretty minimal. And, if you want, you can hire someone to do it pretty cheaply. As for no-shows/late cancellations, they've been very rare in my clinic. The prospect of waiting an additional 6+ months to be seen usually makes most people keep those appointments.

Agreed. My no-show rate is pretty small, especially when reminder calls are provided. Late cancellations can sometimes impact things, but a provider could always keep a running list of patients who'd like to be called for last-minute openings. And you could always charge a no-show/late cancellation fee if you preferred.

 

[WisNeuro]

Agreed. My no-show rate is pretty small, especially when reminder calls are provided. Late cancellations can sometimes impact things, but a provider could always keep a running list of patients who'd like to be called for last-minute openings. And you could always charge a no-show/late cancellation fee if you preferred.

For some, don't believe you can with payors like Medicare, though, hasn't been a problem for me either way. My IMEs no show at much higher rates than my clinical pts, but those have a hefty no-show/cancellation fee.

 

[summerbabe]

Hello everyone,

In terms of income and financial stability, is it better to work in the public sector (hospitals/clinics) or private practice as a neuropsychologist? For reference I live in California.

Thank you.

Not a neuropsychologist but the only thing I'd add to the other great advice you've received is the benefits side of things.

Being the primary bread winner and responsible for income and health insurance for your family is very different than if you have a partner who has a phenomenal employer sponsored health insurance that you can easily join and zero dependents.

And some public sector positions offer great benefits while others don't.