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Private practice

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by lakewood, Apr 8, 2007.

  1. lakewood

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    How challenging is it to open a private practice? Particularly, as a recent PhD/PsyD graduate? Is this a realistic goal for full time work? What are the challenges of a less experienced private practitioner that make this a less viable option?
     
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  3. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    I've heard it takes ~2 years to built a private practice. I haven't gone through it yet, but I think it very much depends on the person, the area you want to work in, your specialty, and how much of a business person you are.

    The way to go seems to be to build it on the side, and if/when you get to a point you can go full time, then you split off.

    -t
     
  4. Ollie123

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    Good question! I'll be curious to see the answer.

    If I were to hazard an educated guess (gotta use my undergrad business degree for something;) ), a psych private practice would be easier to start than almost any other business. Mostly because you'd have unbelievably low initial costs(office, couch, chair, appointment book....that's about it!) I'm obviously making light of it a bit as there are always other things to consider, but the fact that you don't have to lay out as much cash initially means it won't carry the risk of other business ventures where you might have to lay down hundreds of thousands right off the bat for a bigger building, equipment, a large staff, etc.

    That being said, I imagine it carries all the tedious tasks of any new business. Leases, setting yourself up to be covered by insurance policies (unless you go the cash-only route, which can be done).

    The only MAJOR obstacle I might expect would be advertising. You can circulate word to doctor's offices, university centers, etc. for referrals, but I don't have a good sense of what the best way to actually get clients would be.

    Personally, if I WERE going to go the practitioner route (and I don't plan on it), I'd try to get a job practicing in a group for at least a few years. That way you can save up for the few startup costs you will have, plus get to see how someone else goes about running a practice. That's just how I'd go about it though, I'm sure there are people who open up their own practice right away after graduation.
     
  5. pingouin

    pingouin just chillin'
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    I'm a LCSW who has a private practice in a metropolitan area. I was 7 years post-MSW and 5 years post-licensure when I got it going in '05 and it turned a tiny profit even in its first year, and significantly more last year. I only do it part-time (usually 12-15 clients/week) as I have 2 other part-time jobs and I'm in school part-time, but it's as busy as I want it to be. If I wanted to grow the practice, it wouldn't be that hard at this point. I haven't done any marketing in months...

    Connections and networking are the KEY to making this thing a success from the start- I cannot stress that enough. That would probably be the biggest barrier to a brand-new clinician finding success. I have a lot of contacts from previous jobs, who have now moved on and up. I met the group of practitioners I hooked in with as they were heavily-utilized providers for the managed care company I was working for at the time. They had someone leaving and wanted that 20% of the (really cheap) rent paid. (There are 5 of us- all "sole proprietors", so we divide utilities, rent, etc equally.)

    As I started, my colleagues were able to flip me a few referrals which they weren't able to accomodate for one reason or another- scheduling, not on insurance panel, etc. This wound up leading to connections with 2 different psychiatrists, who have been a wealth of referrals. Subsequently, one of those docs has referred 2 of his colleagues to refer their patients to me. My first-ever referral was from a friend who I used to work with doing psych intake. She assessed a kid and thought of me. My suite-mates had done an excellent job of marketing before I joined, and got me onto 2 closed EAP panels solely because I joined their office. CONNECTIONS. My practice could not survive without them.

    Regarding the managed care vs self-pay thing.. in my area, most people start by doing at least some managed care work, and then work their way toward more self-pay as the practice becomes more established. You learn pretty quickly which panels are worth your time- not just who pays the best, but also how much paperwork is required. My suggestion: If you're going to do managed care, try to fill out the applications as early as possible. They take months to process for credentialing. Many places are now using CAQH, so at least you don't have to handwrite all of them anymore.

    Startup costs- chair, desk, couch, sure, all that. You can do it relatively cheap. But ambiance counts for a lot, so things add up when you toss in a rug, bookshelf, wall art, etc etc etc. Heck of a lot cheaper than buying medical equipment, though. As someone mentioned- malpractice insurance. Managed care panels will require proof that you have it. I'm guessing the APA offers a plan? Mine is through the NASW and it's dirt cheap because of the group rate discount, and has good coverage.

    Marketing- I was lucky, my colleagues had done a lot which made my road a lot easier. A lot of my friends work in mental health, so they all got my cards, as did pretty much everyone else I met for about the first 6 months. I knew a lot of the discharge planners at the psych hospitals from when I had worked managed care, so they all got a visit and some cards. We threw an open house last year and invited about 100 contacts to come for free food.

    I've always said- and have never followed up on this- that I think the REAL referral base is with family practice docs and pediatricians. Psychiatrists usually already have their preferred referrals. But what if a clinical psychologist trained in child behavioral mod was to talk with a few pediatricians about referring for an assessment all the r/o ADHD kids who came through before they ran to the prescription pad? I think you could make a mint off of a partnership like that, not to mention the clinical benefit to the families.

    At any rate, private practice is completely doable, but I'd recommend working on the networking thing while being employed somewhere prior to hanging a solo shingle. As a SW, we don't have the option of doing that right out of school (can't practice independently without a license, which takes minimum 2 years post-grad to get), but the work experience I got in the interim was absolutely essential for my practice to get where it has.
     
  6. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    That was a great post!

    Networking is definitely key. Some people will be able to pick this stuff up easily, for others it will be a lot of trial and error. I think the insurance paperwork needs to be talked about a bit more, since it will take a certain % of your time, until you go private pay or hire someone to do the paperwork.

    This is actually an area that I've done some work in before, and will do a lot more work in once I get out and settled.

    -t
     
  7. pingouin

    pingouin just chillin'
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    The problem with the managed care applications is that they require you to know your office address. So if you're filling them out early in order to take into consideration the lag time between submitting them and being credentialed, you may not know yet where your office will be. So I suppose you could stick your home address on there and then send them a change of address form... Long story but I didn't have to bother with some of that so I don't have other advice to give on it.

    If anyone has questions on insurance paperwork such as treatment plans, etc, feel free to ask. Every company does things differently so I don't know how much help I can be, but I'm happy to try.
     
  8. blindblonde

    blindblonde U.S. citizen, Dutch Ph.D
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    Well, the only experience I can cite is what my advisor has told me. He is a professor with a small private practice. He basically started by getting office space with a psychologist who has been in the field for some time. This helped in many ways--networking, having a mentor, and working an established environment. His mentor has given students intersnhips at my school, helped him through navigating the waters of insurance paperwork, and so on. It does take a lot to get started, as indicated by the excellent posts above, and this process helped in his transition.

    I'm sure this was a fairly unique experience, particularly since he keeps a small caseload, but I thought might be helpful.
     
  9. pingouin

    pingouin just chillin'
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    sorry- few more things-

    We save a lot of money by not having a receptionist. CallNotes and cell phones... do all of our own scheduling.

    oh and billing. I do my own (*^&$#* billing. yeah, that's fun. :rolleyes:
    (it's actually not THAT bad, I just feel like complaining because I'm tired :oops: )
     
  10. positivepsych

    positivepsych Member
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    There are no guarantees in private practice. It completely depends on your competency, marketability, specialty/niche, geographic location, networking, connections, business skills, and just plain good fortune.

    Based on the alums I've talked to, I would warn you that it can be very difficult to do it 100% full-time and have a full schedule. I know a few who did it, but most people I've talked to see around 10-15 clients a week, which is not that much. They either live with that, or try to work somewhere else to fill the hours.
     
  11. lakewood

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    Forgive my ignorance, but what is the process for a PhD or PsyD? It's possible to practice without a license? And can you tell me what the licensure process is?
     
  12. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    We have a 1 year internship after completeing a doctoral program. After the internship, there are additional hours that need to be met post-internship. Many people choose to do a post-doc to fulfill these hours. The entire time you are practicing under the license of your supervisor, because you have not taken the licensure exam, etc.

    -t
     
  13. Ollie123

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    Does anyone know if research post-docs ever provide clinical hours to prep you for licensure as well? I realize that will probably depend on WHICH post-doc. I was just under the impression that research post-docs were usually COMPLETELY research focused, and you didn't see clients at all.

    I ask, because I know schools usually prefer their faculty to be licensed so they can supervise students clinical work, but it doesn't look like most faculty have much formal clinical experience beyond their internship, so I don't know what the process would be.
     
  14. doctorpsych

    doctorpsych Junior Member
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    Yes, I believe that a research focused post-doc serves as supervised hrs for licensure. I think this is a technical matter but clinically you may not gain as much if you did a clinically based post-doc. I think there are post docs that combine both research and clinical experience.
     
  15. Ollie123

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    Not REALLY concerned about how much experience I'd actually get as long as I end up with enough hours to get licensed. Know how bad that sounds, but I have near-zero interest in practice so I'm mostly just looking for documentation so I won't have to worry about not being able to find a faculty job without a license.

    Doubt I'll even be doing much treatment research so it will hopefully not pose too much of a problem if I don't have as strong a background in clinical work as those who actually want to become clinicians.
     
  16. NeuroPsyStudent

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    You know Ollie, that is really sad. How can you represent yourself as a clinical supervisor without substantial clinical experience? I certainly would not want to be one of your supervisees.
     
  17. lakewood

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    I don't have the link right now, but one of the links on this forum about average psychologist salary info listed a 10 month salary, or perhaps it was 11 month. I can't find the link to which I'm referring, but what was that about? Who gets 1-2 months vacation a year? Hard to imagine that from private practitioners... right?

    Also regarding licensure: how many post-doc hours are needed after internship? And this is paid time right?
     
  18. Therapist4Chnge

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    I believe the # of hours vary by state, though YMMV. States vary on how they count hours. From my understanding some let you start after you hit the # for internship, others are based on a certain amount of time & # of hours.

    As for paid/un-paid....from what I have seen and heard, they are paid. I'm not sure about informal post-docs (which some people do).

    -t
     
  19. lakewood

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    Generally speaking, how many hours are we talking about? Another 2000 hours or perhaps a one-day afternoon seminar?
     
  20. Ollie123

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    Well that was kind of harsh.
    Its not like I'm intending to blow off my practicum's, internship, etc. That's not my style;)

    I just need to remain realistic about this - psych is too broad a field to have LOTS of experience in everything, and for me, it makes sense to skimp on clinical work (while still meeting all the necessary requirements) since that is the thing that will play the smallest part of my eventual career. I don't want to be a DCT and since I won't be running treatment studies, its pretty unlikely I WOULD need to supervise students to any great extent - I just need to make sure I meet qualifications for when I do it.

    I'm sure there's plenty of people here who will be skimping on things like grant writing, advanced statistics, or consulting, all of which I will have a heavy focus on. Can't do it all in this field. I won't be as good at supervising clinical work, but I'll hopefully be better than most when it comes time to apply for NRSAs or analyze those dissertation numbers.

    Would you feel the same way if someone who wanted to be a therapist didn't do a research post-doc to learn advanced statistical modeling techniques so he could better keep up on the research, and just settled for trying to do well in the stats classes he took? Keep in mind I'm not talking about NOT fulfilling the requirements. I'm just talking about not spending an extra year or two doing a post-doc in something that most likely will not be an important part of my career.
     

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