Questions about private practice

[bmedclinic]

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I'm on internship and until a few weeks ago, hadnt really ever considered joining a private practice. I was set to apply for postdocs (and already had applied for a few) when a family member put me into contact with a psychologist looking to hire another psychologist. Thinking my family member was oblivious, I didnt think much of it. Now, I've spoken with this person on the phone and exchanged a few emails.

The job is as a contract, doing a lot of assessments but also individual therapy and with the opportunity to create future contracts as well. Pay is 57.5 /42.5 % split. Havent discussed expected earnings, but I'm not too concerned with that. They are aware that I will be coming out of internship and will need to be supervised as well while I work on my hours towards licensure, and have been willing to make provisions for that.

I'm hoping I can get some seasoned advice- what types of things should I be wary of (which I might not already know)? My significant other is weary of moving for a postdoc only to move a few years later, and I understand that concern, which makes this type of job where I might be able to set up and live for quite some time more appealing. I've heard some on here speak down towards private practice pay/viability but I'm unsure how true that is, and what other things I need to know.

Thanks in advance. I'm open to any insight and advice you may have.

 

[WisNeuro]

I don't have personal experience with PP, but from colleagues' experiences I would advise you to read the contract over very carefully.

 

[erg923]

I'm on internship and until a few weeks ago, hadnt really ever considered joining a private practice. I was set to apply for postdocs (and already had applied for a few) when a family member put me into contact with a psychologist looking to hire another psychologist. Thinking my family member was oblivious, I didnt think much of it. Now, I've spoken with this person on the phone and exchanged a few emails.

The job is as a contract, doing a lot of assessments but also individual therapy and with the opportunity to create future contracts as well. Pay is 57.5 /42.5 % split. Havent discussed expected earnings, but I'm not too concerned with that. They are aware that I will be coming out of internship and will need to be supervised as well while I work on my hours towards licensure, and have been willing to make provisions for that.

I'm hoping I can get some seasoned advice- what types of things should I be wary of (which I might not already know)? My significant other is weary of moving for a postdoc only to move a few years later, and I understand that concern, which makes this type of job where I might be able to set up and live for quite some time more appealing. I've heard some on here speak down towards private practice pay/viability but I'm unsure how true that is, and what other things I need to know.

Thanks in advance. I'm open to any insight and advice you may have.

First, I certainly wounldn't expect to make much that initial post-doc year. And being an Ind. contractor, I can only assume you have to pay for you own insurance? No 401k (which actually suck, but its better than nothing)? No paid time off? No sick days? No disability insurance? No money for professional development, CEs, licensure fees, etc.? No standard issue life insurance policy? Do you get paid if clients no show? Thats a HUGE one. Make sure they dont write in some kind of crazy committment clause with a penalty for breaking it. If it's a desirable area you want to stay, be cautious about signing no competes.

It's something I explored as well, as the feeedom is tempting, but its is probably not the best for fresh from internship, unless they are really into a training/supervision. I did not find the finances to be very matching with my need, either.

By the way, I would MOST DEF explore the future earning potential! Why would that NOT be something you are coincerned with!? At this stage (assuming you are my age or a bit younger), its should be near the TOP of the priority list, actually. You want to be moving UP for the next 10-15 years. And remeber, the factors I mentioned above (no insurance, no retirements account investments, no paid vacation and sick time) all have to be subtracted from any figure they give you if you want the figure to be comparable and representative of competing "salary" offerings/potentials from public and private sector employers.

 

[AcronymAllergy]

Agree with erg and WisNeuro. Another thing to discuss will be how much assistance, if any, you'll get in finding clients. I'm not all that knowledgeable about PP, but for that kind of split, I'd assume they're hopefully giving you a good bit of help in filling your schedule book with folks to see. From the few folks I know who've done PP, that was one of the more difficult parts of the whole process early on.

 

[Sanman]

Without a doubt, the biggest question should be how you will find clients, will you be able to participate in any insurance or third party reimbursable activities (or will it be cash only?) and how long do other post-docs take to complete their hours. I did PP part-time on my post-doc and I am glad I did not choose full time as they were not able to fill me up easily. By contrast my other position kept me superbusy, this I was able to get my post-doc hours finished in just over 1 year. It also depends on why type of practice you want to participate in after you get licensed. Academic positions in behavioral medicine will be hard to get if you don't do a post-doc. I was in the same position as you and considering similar options. PM me for further discussion.

 

[erg923]

Without a doubt, the biggest question should be how you will find clients, will you be able to participate in any insurance or third party reimbursable activities (or will it be cash only?) and how long do other post-docs take to complete their hours. I did PP part-time on my post-doc and I am glad I did not choose full time as they were not able to fill me up easily. By contrast my other position kept me superbusy, this I was able to get my post-doc hours finished in just over 1 year. It also depends on why type of practice you want to participate in after you get licensed. Academic positions in behavioral medicine will be hard to get if you don't do a post-doc. I was in the same position as you and considering similar options. PM me for further discussion.

If you are into bmed, then get into a hospital setting stat! I didnt do a post-doc in it, but work as a primary care psych in the VA.

 

[Sanman]

If you are into bmed, then get into a hospital setting stat! I didnt do a post-doc in it, but work as a primary care psych in the VA.

Not sure if that was directed more at me or bmed, but I largely am in nursing care facilities and assisted living doing behavioral medicine/geriatrics work. I also interviewed for some primary care positions at the VA, but had not taken the EPPP at the time so no luck.

 

[erg923]

was directed at the OP.

 

[bmedclinic]

Thanks for the feedback.
Erg, let me try to rephrase- At this time, I'm not overly concerned with the finances. What I mean, is, I dont want to be pushy, but I did express that finances are important to me (it's the holidays, he hasnt responded to my email asking about the expected income, but I did ask a few days ago in the last email sent).

The state the job is in (but not part of the state per se) is desirable- so I'd get an opportunity to be back in my home state, but not in my favorite part-- so if I move cities 5 years later, there are plenty of other in state places to go, if needed. At that time, I'd hope to have license portability anyways.

Per the scheduling, I asked about that as it's one of my personal pet peeves at my internship. The % they take is for marketing/scheduling/overhead. From what I've been told, they expect to have enough business next year to hire 3 people, so it'll be up to me how much I want to make. Having said that, I'd still like a ballpark of expected earnings. Without being all to specific, I'll explain what I've gleaned- the owner of one practice is buying a second practice, both successful practices, so as he takes over the second practice (psychologist from that practice is retiring) I'd be stepping in and seeing those clients/doing those assessments/etc.

Finally, I do like behavioral medicine alot. I felt burned by the VA from the internship match and dont think I want to go to the VA for a lifetime. I think that may have been a blessing in disguise at the time. I'm still very interested in academic medicine (and that's where my postdoc apps are to) but as I get above the 3-0 age mark, more and more I find that I might be more interested in flexibility and making what I earn (or my percentage of it) than a salary that someone assigns to me. Honestly, on those things, I'm totally on the fence. I'm even more intrigued about learning at this job before I move on a few years later and have the skills I need to do the same thing.

I dont have this at all planned out beyond what I've written. Just kinda really starting to consider the idea legitimately for the first time. I do like setting up roots, chance to be successful on my own with minimal guidance, and a chance to grow a business doing what I love.

 

[WisNeuro]

No love for the VA. I will tell you not to judge the system by one or two hospitals. We have a saying in the VA. If you've seen one VA, you've seen one VA.

 

[erg923]

What ever "burning" that may have happened (did you not match or something?)has nothing to do with the Veterans Health Administration itself, I assure you. So, I wouldn't punish yourself because of it. If you are Bmed, VAs and academic med is where you are needed, where you can thrive, and where you will make the most money...unless you end up owning a practice or doing a bunch of one-and-dones all day, every day. Do not underestimate the benefit of 4 weeks PAID vacation and 3 weeks of sick leave when you have a family/young ones at home. Do not underestimate the cost of private policy health insurance. Do not underestimate the value of a pension.

Ok, anyway... I guess the verdict is that it could be good, great even, if thats where you want to be and where to want to stay. But given that its an uncertain referal stream (do you know the practice you would actually be taking over...its reputation, its connections, its contracts, how solid/established those contracts are etc?), an uncertain revenue stream (as an unlicesned person, can you bill for all services/clients?), and a variable income with only marginal earnings the first year (I would venture to guess, anyway), its not exactly ideal this early in your career. Is the work at least health psychy? I would strongly caution against going into to uncharted territory or venturing into work that you are less than excited about at this stage. If you don't enjoy what you do 8-10 hours per day, you'll burn...and it's not like you are getting any compensated leave time to recoup from that grind, right?

 

[WisNeuro]

Erg, you forgot to mention the fact that in addition to those paid vacation and sick days that we get every federal holiday paid off. Even the bs ones like Columbus Day. Out of all the job positions that I've looked at this past year, the VA's have by far the best benefits.

 

[erg923]

Have you asked what the academic/scholarly enviorment is like there? Have you inquired about opportunities outside direct service delivery? Again, all important aspects of career development. Its not like you need to be publishing something even, but are there opps for it, or at least opps to excercise the scientist part of your training?

 

[edieb]

What ever "burning" that may have happened (did you not match or something?)has nothing to do with the Veterans Health Administration itself, I assure you. So, I wouldn't punish yourself because of it. If you are Bmed, VAs and academic med is where you are needed, where you can thrive, and where you will make the most money...unless you end up owning a practice or doing a bunch of one-and-dones all day, every day. Do not underestimate the benefit of 4 weeks PAID vacation and 3 weeks of sick leave when you have a family/young ones at home. Do not underestimate the cost of private policy health insurance. Do not underestimate the value of a pension.

Ok, anyway... I guess the verdict is that it could be good, great even, if thats where you want to be and where to want to stay. But given that its an uncertain referal stream (do you know the practice you would actually be taking over...its reputation, its connections, its contracts, how solid/established those contracts are etc?), an uncertain revenue stream (as an unlicesned person, can you bill for all services/clients?), and a variable income with only marginal earnings the first year (I would venture to guess, anyway), its not exactly ideal this early in your career. Is the work at least health psychy? I would strongly caution against going into to uncharted territory or venturing into work that you are less than excited about at this stage. If you don't enjoy what you do 8-10 hours per day, you'll burn...and it's not like you are getting any compensated leave time to recoup from that grind, right?[/quote

 

[bmedclinic]

Good points , people. I really appreciate the thoughts. Erg, I didnt match at a VA even though I interviewed at like 6. Granted, I was really sick all of January and February, but more than that(like I said re: blessing in disguise) I feel that environment may be too structured for me to thrive. Or at least, that's the sense I got.

Either way, very good points above for me to consider. I'll ponder the risk as I go through the next few months of interviewing and determining what fits best.

 

[AcronymAllergy]

Have you asked what the academic/scholarly enviorment is like there? Have you inquired about opportunities outside direct service delivery? Again, all important aspects of career development. Its not like you need to be publishing something even, but are there opps for it, or at least opps to excercise the scientist part of your training?

Another good series of questions. Other than what I mentioned above (i.e., issues with referral streams), a feeling of isolation from peers is the main downside I hear from folks who've moved from AMCs/VAs to private practice. This of course may not be the case with the practice in question, but it's come up frequently enough that I know it to not be an isolated incident. Even something as simple as online journal access (beyond those available through professional memberships) can be sorely missed.

That being said, the raw earning potential of PP definitely exceeds pretty much any salaried position if you're willing to put in the hours and have the needed skillsets. The cons to starting in a PP so early in your career, as others have mentioned, would be the potential uncertainty of supervised clinical hours and other professional development-related odds and ends, the lack of various benefits owing to your contractor status, and (for the first couple years perhaps) the reduced earnings. The pros would include getting your feet wet in the world of PP very early on, and thus having a chance to adjust to the learning curve in time to make a full career of it; having a head start on creating your own referral streams; possibly greater networking opportunities with other PP folks (psych and non-psych) in the area; and perhaps working into an ownership-oriented role either where you are or at a PP nearby.

 

[bmedclinic]

edieb, my internship is applying for APA accred, and already does meet the requirements. It's supposedly retroactive per the training director. That said, except for when I was applying to internships, I've never been too interested in the VA. So if it turns out that's not a possibility it wont really bother me.

 

[edieb]

Good points , people. I really appreciate the thoughts. Erg, I didnt match at a VA even though I interviewed at like 6. Granted, I was really sick all of January and February, but more than that(like I said re: blessing in disguise) I feel that environment may be too structured for me to thrive. Or at least, that's the sense I got.

Either way, very good points above for me to consider. I'll ponder the risk as I go through the next few months of interviewing and determining what fits best.

I am confused. Correct me if I am wrong, but I thought you didn't match to an APA-accredited internship. Unless I am mistaken, I don't think you can work at the V.A. without one.

 

[erg923]

Its not retroactive. If its not APA accredited, your out. Sorry. However, I think you are going to be out of alot of academic med centers too. Yikes!

 

[bmedclinic]

I am confused. Correct me if I am wrong, but I thought you didn't match to an APA-accredited internship. Unless I am mistaken, I don't think you can work at the V.A. without one.

See the next post:

edieb, my internship is applying for APA accred, and already does meet the requirements. It's supposedly retroactive per the training director. That said, except for when I was applying to internships, I've never been too interested in the VA. So if it turns out that's not a possibility it wont really bother me.

 

[WisNeuro]

Ha, the VA being too structured. That's a good one. Maybe just paperwork.

 

[bmedclinic]

Its not retroactive. If its not APA accredited, your out. Sorry. However, I think you are going to be out of alot of academic med centers too. Yikes!

Ok, well that's good to know and I kinda figured that.. Anyways, like I said I'm not all about the VA anyways, so not really a big deal. I know I might be out at some AMC's, and am hoping that my personal contacts might help at places I applied thus far.

AA, I do like the business aspect that you mentioned of getting into a PP business early on in my career and providing the chance to grow.

 

[erg923]

Fair enough, but anyplace outside PP is going to be pretty "structured" assuming that you are refering to time/attendance, deadlines, and note writing. The billiable hours requirements/quotas pushed in the public sector are left completely up to you in PP, because you are only hurting yourself and no one else, right? So, in other words, you better believe there is outside pressures imposed on you in PP. It's just up to you do all of them. In fact, because the VA doesn't have to make a profit what-so-ever, RVU is not exactly pushed like it is everywhere else.

You might want to expand on what you meant by this, cause we may be misunderstanding.

 

[Sanman]

There are not likely to be many academic opportunities in the PP. the bigger question is what will your split be and your opportunities after post-doc? Will you essentially be a partner covering a portion of expenses or will you continue with same split? Is the practice big enough to afford you management opportunities?

 

[AcronymAllergy]

Its not retroactive. If its not APA accredited, your out. Sorry. However, I think you are going to be out of alot of academic med centers too. Yikes!

I could be wrong, but I thought it was retroactive to the date of the last site visit. I know that's the case for grad programs, anyway.

 

[erg923]

Right, IF the site visit ocurred while you were on internship there. If it occured AFTER you completed the internship, it is not.

 

[Sanman]

Fair enough, but anyplace outside PP is going to be pretty "structured" assuming that you are refering to time/attendance, deadlines, and note writing. The billiable hours requirments/quotas pushed in the public sector are left completely up to you in PP, because you are only hurting yourself and no one else, right? So, in other words, you better believe there is outside pressures imposed on you in PP. It's just up to you do all of them. In fact, because the VA doesn't have to make a profit whats-so-ever, RVU is not exactly pushed like it is everywhere else.

You might want to expand on what you meant by this, casue we may be misunderstanding.

Well the one thing that I enjoy about the non-VA world is being better able to set my own hours. I don't have a set 'tour of duty' and do not need to be in at 8 am. That said, you may need to work evenings or weekends because that is when the clients are available. Personally, I like working later, but the SO does not like when I am not home for dinner. Now, I am more of a 10:30-7:30 schedule. I find that rvu and production is not an issue for private practice because bills need to get paid and there is no need to waste time at work of you are not billing.

 

[WisNeuro]

I could be wrong, but I thought it was retroactive to the date of the last site visit. I know that's the case for grad programs, anyway.

ALso, I think it has to be the site visit where they decide to grant accredidation, not one of the visits leading up to it.

 

[edieb]

Ok, well that's good to know and I kinda figured that.. Anyways, like I said I'm not all about the VA anyways, so not really a big deal. I know I might be out at some AMC's, and am hoping that my personal contacts might help at places I applied thus far.

AA, I do like the business aspect that you mentioned of getting into a PP business early on in my career and providing the chance to grow.

One thing I would highly recommend to you is to join the state psychological association where you would like to settle and become active on their listserv. Your best chance to find a good job at a place like an academic medical center will be on there.

 

[WisNeuro]

Well the one thing that I enjoy about the non-VA world is being better able to set my own hours. I don't have a set 'tour of duty' and do not need to be in

Comp time and alternative work schedules my friend. Varies depending on what area you are in, but it's an option in places. I like the 7:30-4 tilt though, so, no complaints here.

 

[erg923]

You can mildly "flex" in the VA. Shorter lunch, 730-4 or 830-5, etc. I am not sure where else besides PP and the contract-type work that I know you do where one can truely set there own hours. All hospitals and other clinics I know of will want coverage and clincians present during normal working hours.

We just hired someone here (health behavior coordinator) and they are going to do 12-8 on Mondays, something to do with an ongoing data collection project. I think that was required though, so not exactly flexible, lol

 

[bmedclinic]

Well this thread kinda became a "you should work for the VA" beatdown. For those that gave thoughtful responses to what my stated questions and desires were, I appreciate that.

 

[WisNeuro]

Well this thread kinda became a "you should work for the VA" beatdown. For those that gave thoughtful responses to what my stated questions and desires were, I appreciate that.

Well, I think it was more of just a "correct misconceptions about the VA" flavor. We're used to people having a misguided view of what the VA is, and we like to correct that. Heck, I had a disdainful view of the VA before I ever worked there. Most of my preconceptions were wildly inaccurate.

 

[erg923]

Well this thread kinda became a "you should work for the VA" beatdown. For those that gave thoughtful responses to what my stated questions and desires were, I appreciate that.

No, but I think there is concern that you will be losing out on your claimed specialty if you diss the leading employer of psychologists with this specilaization. Outside the VA and large academic meds, I think you might be dissappointed to see that truely intergrated behavioral medicine hardly exists. However, this was all before we knew about your internship. But even now, I think people are just warning you of the sig financial drawbacks/limitations of working for others in a PP vs taking a more secure hospital position.

 

[bmedclinic]

Well, I think it was more of just a "correct misconceptions about the VA" flavor. We're used to people having a misguided view of what the VA is, and we like to correct that. Heck, I had a disdainful view of the VA before I ever worked there. Most of my preconceptions were wildly inaccurate.

Super.
Let's move on, and perhaps talk about what I might need to know to work in private practice.

Sanman, the owner of the practice stated he is not interested in being a partner. That was disappointing to hear. I sense that he makes a lot of money and has no interest in sharing profits given his years of experience and work he's put into getting to this point. Cant blame him for that. However, my thought is that perhaps I'll learn enough that I'll be able to go out on my own a few years later with the knowledge and business skillset needed to do it on my own. I do wonder if I'd be able to work my way to being in charge of the second site that he's taking over, in time.

 

[bmedclinic]

No, but I think there is concern that you will be losing out on your claimed specialty if you diss the leading employer of psychologists with this specilaization. Outside the VA and large academic meds, I think you might be dissappointed to see that truely intergrated behavioral medicine hardly exists. However, this was all before we knew about your internship. But even now, I think people are just warning you of the sig financial drawbacks/limitations of working for others in a PP vs taking a more secure hospital position.

Those are all fair concerns. Along with those, I'm also wondering what's more important- practicing a niche area of psychology or having the non-professional life (being close to family, flexibility, etc) that I desire. Bmed isnt the only aspect of psychology I enjoy- I've done a lot of varied assessments and enjoy all of those (except evals for kids in schools, which I do not enjoy much at all).

I've valued the feedback related to the original question in this thread. If there's any additional things for me to concern myself with as it relates to private practice, feel free to message me.

 

[WisNeuro]

Also, I imagine the landscape may change considerably with the ACA. I, for one, do not envy anyone who has to wrestle with insurance companies to get paid.

 

[Sanman]

Super.
Let's move on, and perhaps talk about what I might need to know to work in private practice.

Sanman, the owner of the practice stated he is not interested in being a partner. That was disappointing to hear. I sense that he makes a lot of money and has no interest in sharing profits given his years of experience and work he's put into getting to this point. Cant blame him for that. However, my thought is that perhaps I'll learn enough that I'll be able to go out on my own a few years later with the knowledge and business skillset needed to do it on my own. I do wonder if I'd be able to work my way to being in charge of the second site that he's taking over, in time.

In that case, pay particular attention to the non-compete clause in your contract if there is one and make sure you are comfortable with it if you need to leave. The other question is how hard it is to get on insurance panels once you are licensed in that area. Personally, I had likes and dislikes about PP. You may need to do child assessments for a while as they are one of the things that are often paid for in cash.

 

[AcronymAllergy]

Also, building on something erg said re: the lack of bmed outside of AMCs/VAs--perhaps this is an area on which you could focus when building your referral base, particularly with local physicians? I'm sure there are plenty of folks who'd be interested in receiving services at least somewhat similar to what's often offered in primary care mental health (at least as is feasible) in a PP setting, and plenty of physicians who'd refer their patients if they knew what it was you did.

 

[erg923]

Along with those, I'm also wondering what's more important- practicing a niche area of psychology or having the non-professional life (being close to family, flexibility, etc) that I desire.

Right here. PP makes up for this in one big way, once you are up and running and have the appopriate cash cushion saved-it allows flexibility of time and schedule. It generally does NOT allow for less hours worked per week and it does NOT provide the security for those non-professional life priorities that having an employer does. I am a little pissy at the moment but do you have any idea how much children cost you in terms of money AND time. lol. In PP, you can miss work all you want to take care of your kid(s), but you don't get paid for that time. Its a huge finacial AND mental burden, I assure you. Also, what is your loan situation like? Havin an employer means having possibility of assistance with those payments each month. PP, probaly not.

Perhaps one prime example I would add of a having a stable income with benefits is that my wife and I are able to set aside the tuition for my sons (and now daughter) mildly pricey Catholic education without much headache and with HELP from my employer (OK and a finacial advisor). This a personal choice of ours yes, but its a good example. I am able to do this by 1.) having a set income that grows based on a predetermined schedule. 2. having an tax defered IRA from an employer that they also contribute to.

 

[Therapist4Chnge]

Understand that the PP owner is looking strictly for production & not development of a partner/associate. Knowing that I'd want to really examine the details of his contract, which will most likely skew everything in his favor. Non-compete following employment, limitations on outside employment/earning while working there, and split of earnings v. covered services like referral source development & scheduling would be of most interest to me. Non-compete clauses vary widely in scope and applicability (e.g. Cannot be overly restrictive but can still have teeth)

 

[Sanman]

Right here. PP makes up for this in one big way, once you are up and running and have the appopriate cash cushion saved-it allows flexibility of time and schedule. It generally does NOT allow for less hours worked per week and it does NOT provide the security for those non-professional life priorities that having an employer does. I am a little pissy at the moment but do you have any idea how much children cost you in terms of money AND time. lol. In PP, you can miss work all you want to take care of your kid(s), but you don't get paid for that time. Its a huge finacial AND mental burden, I assure you. Also, what is your loan situation like? Havin an employer means having possibility of assistance with those payments each month. PP, probaly not.

Perhaps one prime example I would add of a having a stable income with benefits is that my wife and I are able to set aside the tuition for my sons (and now daughter) mildly pricey Catholic education without much headache and with HELP from my employer (OK and a finacial advisor). This a personal choice of ours yes, but its a good example. I am able to do this by 1.) having a set income that grows based on a predetermined schedule. 2. having an tax defered IRA from an employer that they also contribute to.

Well yes and no. Your vacations are somewhat flexible, but PP people usually end up taking vacation at the usual times because their clients do as well. No sense in working Christmas Day and not New Year's Day. I think there is a balance and PP can work out well depending on your situation. Agreed that you do not get paid on your days off as a contractor, but if you need more time off than allotted as an employee it might be worth it. I know it was nice having the flexibility to take off for a week on fairly short notice (two weeks) as my spouse cannot do that and if we were both in the same boat it would be an issue. I agree that PP pays off financially better than employment mostly when you own the practice. That said if financial motivations are not your largest concern, it does offer great flexibility as a supplementary income.

 

[bmedclinic]

Erg,
I dont have kids, and I do have loans. And the wife wants kids (and so do I, just not in the same way- no biological clock). I appreciate the examples in terms of education, savings, etc.

T4C, thanks for the heads up re: contract. My sister (who knows this guy personally) is a lawyer and I had planned on having her look over the contract if we got to that point regardless. I know there's a noncompete within a certain radius, which is fine-- I think if I was going to go somewhere else in that state (my home state) I'd go to a different part anyways as I've lived in 3 other cities there and otherwise wouldnt have ever thought of living where the practice in question is located. I asked specifically about my cut if I bring in new referral sources, etc. He didnt give a definite response but sounded very open to that.

 

[paramour]

Erg & T4C (& I suspect others I've overlooked) already posted some fantastic points for you to remember. It does bear repeating: Pay extremely close attention to your contract!

Sanman, the owner of the practice stated he is not interested in being a partner. That was disappointing to hear. I sense that he makes a lot of money and has no interest in sharing profits given his years of experience and work he's put into getting to this point. Cant blame him for that. However, my thought is that perhaps I'll learn enough that I'll be able to go out on my own a few years later with the knowledge and business skillset needed to do it on my own. I do wonder if I'd be able to work my way to being in charge of the second site that he's taking over, in time.

Understand that the PP owner is looking strictly for production & not development of a partner/associate. Knowing that I'd want to really examine the details of his contract, which will most likely skew everything in his favor. Non-compete following employment, limitations on outside employment/earning while working there, and split of earnings v. covered services like referral source development & scheduling would be of most interest to me. Non-compete clauses vary widely in scope and applicability (e.g. Cannot be overly restrictive but can still have teeth)

I also would attend closely to what T4C has posted here (in bold print). If the owner is not looking for a partner, you may receive minimal (to zilch) re: the requisite knowledge & skill set to branch out on your own at some point. Our contracted therapists know absolutely nothing about the business other than "I collect paperwork/money from clients and submit my notes/paperwork as evidence of services." If management or eventually venturing into business on your own is something you are interested in doing, then you may need to advocate for yourself and ask specifically that you be provided at least the opportunity to understand the basic policies & procedures in running the business (thinking of reasons why this would be to the owner's benefit might help?). That is if you have the time in addition to clients, notes, meetings, etc.

I don't believe you mentioned either way (unless I missed it!), but there are situations where the owner(s) of agencies are not the ones running things and really haven't the slightest what's going on business-wise. For example, there are 3 co-owners where I'm employed at the present time. Two of them (both therapists) have absolutely no knowledge re: the business itself and leave it to others to keep it up & running--and they truly don't have the time to invest in anything else anyway. Is your owner involved or does he delegate running the business to others?

In addition to erg's & T4C's recommendations re: contract details, I'd consider inquiring about whether or not there is the opportunity to revisit your split after you've been there for whatever timeframe you would consider reasonable (particularly if you don't consider your initial rate to be acceptable indefinitely). I know that we've had one therapist successfully renegotiate her rate, but this also was done based on the language written into her contract. I'm not sure most of the incoming therapists even think about it.

G'luck~

 

[woodstock219]

While I am not at nearly at the level of professional development of most respondants here (I'll be referencing masters-level contract work), I do have a few thoughts as someone who worked both contract and employee. First, I do agree that your contract option does give you a bit more flexibility in regards to scheduling your hours and vacations. However, a badly contracted situation (as I got myself into, I was doing in-home work over a three county area... an hour and a half of driving only to find out the family was out for the day) can become harmful as no-shows can end up wasting your time without getting you paid a penny. I had several weeks where a paycheck was abnormally low simply because I had five or six no-shows that week, and although I ended up still having to document that I took time out of my day to get to the office and make preparations for the upcoming meeting, and then drive to the home, without getting paid for any of that preparation.

Also, be very careful of both the non-compete clause (as stated above several times) as well as the reality that contract work puts the "employer" in a much stronger position of power. If they get into a disagreement with the way you are doing things or feel you're not putting in the quantity of time they'd want, they have virtually no impetus to keep you as an employee (unless your contract obligates them to). They can simply state that there is no longer a need for the service and leave you high and dry the next day. Without a well-written contract, you've got quite literally no job security. The power also swings their direction in regards to employee education and improvement. If you're looking to advance your skills and get the CEs required to remain clinically relevant, you're typically going to be paying for that yourself. Thus, the employer gets an employee who is improving continuously without paying out anything on their end. Plus, since you won't be seeing clients at that time you're looking at a situation where you may not get paid anything for the time you invest in those CEs.

While I will fully admit that I'm a single case example and not indicative of a trend, it was my personal experience that the contract money ended up not really being any better than an employee pay: while I "made" more on the front end at a given time, I ended up expending an amount in keeping up with all of these other factors (insurance, time off, CE time, professional fees, etc) which brought me down to almost the exact same level as what I would have made as an employee somewhere.

Hope this was of help!

 

[paramour]

^^ The above post prompted another reminder: Determine whether you get paid regardless of whether your clients pay OR only if & when your clients pay. If the latter, you may occasionally find your paycheck a bit short.

 

[Sanman]

^^ The above post prompted another reminder: Determine whether you get paid regardless of whether your clients pay OR only if & when your clients pay. If the latter, you may occasionally find your paycheck a bit short.

To add to this, who is responsible for collections (you or the practice) and will you be paid as third party reimbursements come in or immediately following the session. Third party reimbursements can take weeks to months to show up and you don't want to be waiting on session payments 6 months after a session.

 

[Pragma]

To add to other good points made already - just on the surface, the split sounds rough and I am not familiar at all with the nuances of doing a postdoc outside of a larger institution. What I can say is that when I get approached about consultation or clinical opportunities, it is usually tied to my AMC background. I think if there is a way to do it more formally at an institution, you might be better off based on some of the things erg mentioned as well as from a marketability standpoint. But I am biased by my own experiences and what I have heard about people doing informal postdocs on the job market.

 

[erg923]

To add to other good points made already - just on the surface, the split sounds rough and I am not familiar at all with the nuances of doing a postdoc outside of a larger institution. What I can say is that when I get approached about consultation or clinical opportunities, it is usually tied to my AMC background. I think if there is a way to do it more formally at an institution, you might be better off based on some of the things erg mentioned as well as from a marketability standpoint. But I am biased by my own experiences and what I have heard about people doing informal postdocs on the job market.

My "post-doc" was as a visiting assitant professor with some service in the CC one day per week. This has actually served me VERY well in my obtaining other positions, although this has more to do with the networking that happens in academia, especially since I was involved in training and supervsion as well. I got introduced to probably 70% of the psychologists in this city that year. I learned a great deal that year, albeit, I learned very little about psychotherpay, per se.

 

[Therapist4Chnge]

The split is definitely not in your favor. For one yr if you can get all of your hours than that may be okay, but once you are licensed that is not a "going" rate.