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Salary range for joining group private practice (both full and part time)

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by Childdoconeday, Jul 12, 2018.

  1. Childdoconeday

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    Hi everyone,

    I am currently working with young adults who have severe psychopathology in a residential treatment setting. It's interesting challenging/work, but I miss working with a higher functioning population, and eventually see myself working with clients in a private practice. I also miss testing and want to strengthen my testing abilities, so I would like to join a private practice to continue to build on those skills. The benefit of my current job is the salary is pretty good (70k), the health insurance is unbelievable (best I've ever had in my life), and I have over 30 days of vacation leave. As a new mom, I appreciate that!

    There are some private practices who are looking for psychologists in my area, but something that stops me from responding to their ads or reaching out is that I feel like I don't want to pursue any opportunities until I know more about the setting/salary expectations. My husband and I would like more children, and ideally, I would love to work part-time, but don't know if we could afford that at this point.

    I'm wondering if any of you can shed light into the life of joining a group private practice.

    1). If you work part-time, what does your schedule look like? What is your salary range?
    2). If you work full-time in a private practice, what does your schedule look like? what is your salary range?

    Thank you!
     
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  3. Doctor Eliza

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    I don’t know about your area, but in my city group private practices pretty much exclusively use independent contractors. So say goodbye to that paid vacation, health insurance, and 401k. Compensation for straight therapy after the split with the practice would probably make it hard to reach 70k for full time hours.

    On the bright side, it can be nice to work part time with small children. I also enjoy having clerical and billing support. I like the high functioning population i see. I’m clear that I’ll never get rich working for someone else, though. It’s not the long term plan, but it works for now.

    Best,
    Dr. E
     
  4. PSYDR

    PSYDR Psychologist
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    70k is well below the median salary for clinical psychologist according to the APA salary survey. IMO: the salary is extremely low. I have never been offered a job less than 80k for part time work.

    Look into the thread about day to day stuff.
     
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  5. Sanman

    Sanman O.G.
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    PP salary is really going to be dependent on the practice/ deal being offered, the payor sources, and the SES of the city/local area. In contrast to Dr. E, most of the people that worked full-time at my practice and were fully licensed cleared over 90k. This was is a high SES area in a practice that saw children and adults, but was more established as a child practice. Though, as I recall, the practice Dr.E works for is abnormally large and is not a generous with clinician split and fees. What is similar that we were all independent contractors and made our own schedule assuming available office space. However, unless you are simply splitting costs with other clinicians, being your own boss pays better than working for others. That said, if you are trying to be part-time, an established practice with referrals and support may be ideal. I would also echo PSYDR in that I was never offered less than 80k for a job, though benefits were meh.
     
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  6. foreverbull

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    Part-time private practice can range widely depending on how well-established you are and whether you take insurance, etc. In your own practice, wth 5 clients/week full fee you might clear around $30-$33K before taxes and business expenses. After taxes and operating expenses, that's about $12-15K net income. If you have your own PP, you'll need 7-10 weekly clients to make more than pocket change, from my own experience in PP. I'm approaching one year of PP and have around 3-5 weekly clients (i don't take insurance but I live in a middle class area, which is difficult). My colleague and I are still building our group practice. I make little more than pocket change, so thankfully I work elsewhere on the side and have another income earner to support me.
    Some colleagues are fulltime but are paneled and take insurance, but reimbursement can be anywhere between $60/hr-$90/hr so full time (16-20 clients/week) they make okay money. The big bucks come from full fee + full-time client load (20/week), and/or specialized services like assessment.
     
  7. smalltownpsych

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    I would think that part-time is easier to do in a salaried type of job than a private practice. I have been working in a hospital clinic for the past few years which is setup to run much like a small group practice and can tell you that it is extremely demanding and it takes full commitment to keep the client load where you would want it. It is very difficult, if not impossible to scale it back. In other words, when I started I pushed hard and got to a full client load in a few months and kept that energy going for about a year during which my monthly take continued to grow. I couldn't sustain that level of energy and since I was making bank, I began to schedule a few days off here and there. My monthly take nose-dived almost immediately. There are too many variables for me to explain in this short space, but in short it is not so straightforward as x amount of client hours will equal x amount of dollars.
     
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  8. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty
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    Wow. I didn’t realize commercial reimbursement was so rough for therapy. Doing it part-time can be tough unless you can figure out a way to keep overhead low AND get decent rates. I know clinicians who only take a couple/few insurance plans that reimburse the best and forego the rest because it doesn’t make financial sense to take a 20-30%+ discount for lesser plans for the same amount of work.

    Employee assistance programs (EAPs) tend to have better rates. It is mostly short-term cases with specific dx/problem referrals, so it’s often not steady enough unless you have multiple companies contracted. EAP work seems to require networking and developing a reputation bc there isn’t a formal channel to find the opportunities.

    I’d caution against doing part-time assessment work unless you have a strong background already in it because there can be a steep learning curve besides the ethical considerations regarding scope of practice, etc. You typically don’t carry a patient load, which could be good or bad....depending on what you want to do.
     
  9. foreverbull

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    Sutter Health contracts with Kaiser to get clinicians to provide therapy (Kaiser refers all individual clients to Sutter because they're so busy) and I recently got a letter offering $60/session to contract with them. No joke. Some insurance does go up to the mid-$90s per hour (usually Medicare), but in my area, most are in the $75-$90/session range, I think? Reimbursement does vary by region, I should add.
    You actually do a lot more work to get insurance reimbursement if you submit the claims yourself, so you spend more time making sure you're submitting the superbills correctly and fighting insurance companies to be reimbursed less. Some groups take care of the reimbursement side of things for you (and hire a biller/admin), which is nice.

    I should stipulate that my info was based on someone paying for their own business expenses (rent, insurance, licensure fees, advertising, office supplies, etc.) in a group practice, whereas some groups will provide the office and just take out a bit of a chunk of your fees for it, so that might be a better deal, perhaps? You'd have to do the math.
     
  10. chrostopherhenandex

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    New hires at my current practice start at 60k (with opportunity for raises if hours are met and good benefits like insurance with no premium).

    The real bread and butter is private pay stuff (either assessment and treatment).
     
  11. Childdoconeday

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    Thanks for your response. What kind of jobs are offering you 80 k for part time work? If those jobs exist, I would happily leave my full time 70k job :) The other responses to this post were very different than yours. Specifically, it seems like I would have to really hustle and have a nice size caseload to even make 70k in private practice. I'm confused by the difference in the responses!
     
  12. Therapist4Chnge

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    I’m guessing the jobs involve forensic evaluation with expert testimony. It’s a great niche area, but it is far far different than talk therapy.

    There are some grinder forensic jobs that regularly advertise for $60k-$80k/yr for full-time work. Those jobs tend to be be tough and often have high turnover.

    I used to see the same job posting pop up over and over again to do employment screens for police officers. From what I could tell it was not a good position. Assessment work will likely always pay more, but it requires more training and may involve the court system in some capacity.
     
  13. PSYDR

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    I could go into this, but most of it is just me being willing to work more than others and tolerate more risk. Remember that at $100/hr, one only needs to work 3hrs/day, 7 days/week to hit $100k gross. That's not hard at all, but most would balk at working weekends.

    The best way to make money is to have an endless referral stream or 8 and be self employed. Once you have this, you can modify your income by making more per hour (e.g., higher paying specialties, better insurances, etc), work more hours, or use a multiplier (e.g., psych tech, psychologist employees, sell a book which is a stupid idea but people seem to insist on doing that). Reducing overhead is a fool's errand.

    I honestly believe that the lack of income in this field is mostly due to poor work ethic.
     
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  14. Sanman

    Sanman O.G.
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    Full-time 20 clients a week? That seems low to me. We used to book more significantly more than that per week. 7-9 booked with some no shows.
     
  15. Sanman

    Sanman O.G.
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    That may be some of it when you compare to physician colleagues. However, I think it is a blanket lack of financial education and being unwilling to put the business first. From sliding scale to unpaid work, we are willing to ignore business concepts more than anyone except maybe social workers (which explains their incomes). It blows me away the number of veteran colleagues I meet that don't know the first thing about billing codes or reimbursement rates. I may not the best/most knowledgeable clinician in every room I walk into, but I am often the most business savvy (my old boss being an exception to this). You can't negotiate a salary or adjust overhead appropriately if you don't know your billables.
     
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  16. foreverbull

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    In my area, many psychologists in PP consider it questionable to see more than 20 clients weekly (with notes/calls/billing/admin time on top of client time).
     
  17. Sanman

    Sanman O.G.
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    I'm sure they do, but back of the napkin math says you are grossing less than ~75k after modest vacation time if accepting insurance. You couldn't sustain a practice with such low volume in my area, overhead would eat you alive. Standard practice was booking 30-40 and catching up with things when you have no shows. 20 is only sustainable in a private pay model, IMO. Hell, I know places that expected 60 sessions per week for FTEs.
     
    #16 Sanman, Jul 13, 2018
    Last edited: Jul 13, 2018
  18. smalltownpsych

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    I agree with PSYDR that 70k is not a good paying job. In my mind a full-time newly licensed psychologist should start at 80k. At this point in my career (licensed for about 8 years now), I wouldn't even glance at a job that was less than 100k and am actually going to be making quite a bit more than that.
     
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  19. PSYDR

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    That just means that the practice does not have enough admin staff, policies and procedures, and boundaries. See patient, write up the note, hand note to admin staff to fit into professional format, have all notes ready for you to sign when you walk out, require all patient communication go through admin staff so you are not giving free services such as patient calls, outsource billing or have it in house and refuse to take insurances that require pre-auth or kick claims back too often.
     
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  20. Ollie123

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    Never in a million years would I expect a salary thread to make me incredibly glad to be in academia...
     
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  21. foreverbull

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    I should have clarified this is assuming private pay only.
     
  22. Sanman

    Sanman O.G.
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    Well that makes more sense. Private pay is more about quality of services vs volume, capping your client load at a lower level will help to sustain quality over the long-term.
     
  23. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    I imagine that this would be highly dependent on what you are actually bringing in at an hourly rate.
     
  24. Sanman

    Sanman O.G.
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    True. My assumption is that you are pulling in significantly more than insurance would pay you (maybe $150-200 /session). If you are not pulling in more than insurance, no reason not to opt for that model and fill your slots quickly, IMO.
     
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  25. CWard12213

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    I don't understand this at all. How does it take you 20 hours a week to document and bill on 20 appointments? I usually benchmark 10-15 minutes of non face to face time for each therapy session. An hour of paperwork a day is all I book myself, knowing I will gain a few additional hours from cancellations. I book 35 face to face hours per week.
     
  26. foreverbull

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    It's not just about the admin time, which wouldn't be another 20 hours; it's more about the drain of seeing so many clients weekly for full sessions and its effect on one's work/wellbeing. Several psychologists I know have talked about this as a potential concern of burnout and impairment and that you don't need any more than 20 if you're private pay. It's seen as a general rule of thumb where I am, but pretty consistent across psychologists I've spoken with.
     
  27. erg923

    erg923 Regional Clinical Officer, Cenpatico National
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    This seems to overly generalize peoples tolerance, resilience, and overall temperament. Is there any empirical basis for such an assumption? I cant imagine any other health profession concluding such a thing.
     
  28. AbnormalPsych

    AbnormalPsych Clinical Psychologist
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    Just to chime in, my grad program also taught this 20 session rule of thumb for PP. It was the norm in the city for PP folks, for the reasons quoted here. I have never been in a therapy based PP so I don't really have any opinion. I'm sure I would be tempted to go above this though to account for no shows and just to make more money in general.

    Edit: Also, in this city, all these people took cash primarily, with a few slots reserved for sliding scale or those on the University insurance.
     
    #27 AbnormalPsych, Jul 25, 2018
    Last edited: Jul 25, 2018
  29. foreverbull

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    I've never heard where the number came from, although I'd also be interested to know if there is research around this in PP.
     
  30. chrostopherhenandex

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    I think there is also a tremendous amount of variance in people's ability to hustle and grind. I've often thought of my ideal load but sometimes that is competition with the skrilla I'd like to make.

    Can anyone think of the flaws in this model?

    The fun part:
    -I'd like to get to work around 9 pm.
    -Ideally, I'd like to see 2 or 3 patients a day (I work with kiddo's, so that would be from like 3pm to 6pm).
    -I would also like to do 1 to 2 evaluations per week and not have to deal with insurance.
    -I'd test in the morning/early afternoon and report write/interpret then, too.

    The fun math:
    -10-15 sessions per week (at $125; a conservative estimate for my area) nets $1250 to $1875 per week.
    -I'd like to bill at least $1000 to $2000 per eval. So 1.5 evaluations per week nets another $1500 to $3000.
    -Thus, weekly income could vary from $2750 to $4875. Monthly that's $11,000 to $19,500.
    -Let's say I work 44 weeks per year that's $121,000 to $214,500 net or $80,000 to $140,000 after Uncle Sam takes his share.

    Startup Expenses (not the fun part)
    - furniture $3000
    - tech $2000
    - tests $8000
    - deposits $2000
    - misc (e.g., logo design etc.) $5000
    - Totals $20,000 wish


    Reoccurring Expenses (I'm being conservative, monthly).
    - Rent $1000
    - Health insurance increase for joining wife's plan $400
    - Electricity $100
    - Internet $100
    - Testing materials $300
    - Insurance $300
    - Misc/other $500
    Total = $2600ish monthly, yearly we're at $31,200 before retirement contributions!

    So it looks like you'd bring in $60,000 to $110,000 in private practice. Granted, my estimates are not the most lean and Warren Buffet would not like my P:E ratio. You also, work harder. You could probably cut a lot of fat back here.

    One reasons I'm glad I am not going to a private yet is that whenever there is an incentive to work more is involved, I tend to become a work-a-holic. There is also risk here, too.
     
  31. chrostopherhenandex

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    I agree about the poor work ethic. It's like many psychologist don't know what real-work looks like. There were two formative experiences in high school that made me decide to go to college (1) I got an arm sunburn from scooping French fries all day at Burger King, and (2) getting up at 5am to work with my dad on roofing or building barbwire fences all day in the heat. .
     
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  32. psych.meout

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    How do you get sunburn inside a Burger King?
     
  33. CWard12213

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    So what do you do with the rest of your time? At any private practice I've worked at, 20 hours a week of patient contact would be considered part time.
     
  34. AbnormalPsych

    AbnormalPsych Clinical Psychologist
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    Enjoy life?
     
  35. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    In this particular model, it's just not worth it. I already make more than that, working 30-35 hours a week, and I get benefits and retirement. Also, if that's a cash only practice, you have to plan in for no-shows/late cancellations. What's your policy on those?
     
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  36. PSYDR

    PSYDR Psychologist
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    1) demand is dynamic, not static. When working with children, the demand has a pattern that sort of follows the school year. Once a week assessments are probably not going to work. It’s more like you’ll have zero demand for months and the have 12 assessment requests in a month for a few months. Same for therapy, unless you are one of these bad therapists that have someone in therapy for a decade. Then there is the entire “it’s slow because I’m starting out” thing. And the entire “what do you do if you’re down with the flu for 2 weeks?”.

    2) Handling all administrative duties such as scheduling, billing, is more work than you’d expect. Patients call and want a response now. Maybe over a clinical issue, maybe over a perceived billing error. Imagine what happens when a kid who you have tested gets divorced.

    3) you’re missing NNN, and office insurance. The former is expensive, the latter is not. But slip and falls happen.

    4) you need a real attorney to draw up the LLC, informed consent, office policies, etc. Do not use legal zoom. Then you need a real accountant that you get to see every quarter.

    5) your rent estimate is ridiculously low.

    6) because of #1, you’ll need an LLC that pays you a regular salary, so when you have no patients you stil have income. Or when you have an operating cost like a new laptop.

    7) get an Amex business platinum.

    8) your taxes are off, because when you’re self employed you pay both sides of social security on the first $100k. And the irs tends to estimate that your income goes up like 15% every year which can mean you owe a buttload in quarterly payments which then get refunded.
     
  37. smalltownpsych

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    Last four and a half years I booked a solid 40 patient hours a week and had one week of call every four weeks. It was quite a grind and I could not sustain that for the long run, but it really helped me to pay down significant debt and build up some capital. 20 hours a week would be a pretty minimal amount of work in my mind and it is close to what I did during practicums while having the other obligations of the doctoral program.
     
  38. AbnormalPsych

    AbnormalPsych Clinical Psychologist
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    Damn. Nicely done. Was this in solo PP? Or what kind of set up?
     
  39. foreverbull

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    My business overhead is about $850-$1000/month, but I scrimp on certain things (no office internet, no office landline, no hired staff or contracting for billing, relatives do taxes for free), have cheap office rent, don't offer assessments, and don't spend much on marketing. Depending on where you are and what you opt for, business expenses could be anywhere from $10k a year up to $35-40k, depending on needs and area. It's a large range with a lot of factors involved. Your estimate is at the higher end, it looks like.
     
  40. chrostopherhenandex

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    The thing that holds the fries after frying has a heat lamp. The salt also made my skin very upset with me, too.
     
  41. biscuitsbiscuits

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    Tangent here, but wondering what people would think of a practice in a WeWork building. Cost of private office plans depend on location, but start at $450/month (the one closest to me is 760/month) which includes the dedicated, locked office and things like internet and free access to a printer. Seems like privacy would probably be the biggest issue - not sure if the walls are all glass(?), and clients would have to sign in at the front desk. But I wonder if it could work if privacy could be secured.

    I'm not actually interested in PP, just curious about coworking spaces in general. ¯\_(ツ)_/¯
     
  42. psych.meout

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    Where I'm from, we just call those "burns."

    By "free printer" do you mean a common printer shared by other people who are not part of your practice? That's a HIPAA violation waiting to happen.
     
    #41 psych.meout, Jul 25, 2018
    Last edited: Jul 25, 2018
  43. biscuitsbiscuits

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    Uh... You're not forced to use the printer so natch wouldn't use it for patient docs. But
    I'd use a free printer every chance I got for Amazon returns.
     
  44. psych.meout

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    Regardless, this seems like a bad idea to save a bit on overhead, just like people seeing patients in their "home offices." As has been talked about previously, worry less about reducing overhead and more about increasing revenue (e.g., have admin staff so you focus on maximizing billable hours instead of worrying about stuff beneath your pay grade).
     
  45. smalltownpsych

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    An outpatient clinic that was part of a hospital. Had two office support staff for three psychologists and one PMHNP. It took me about two months to build up my caseload which was somewhat record time. When I was still going strong and not as burned out, I was booked for two months out. The last year or so as my energy began to wane that trickled back to about a month out. Truth is, that if I had more control over how I managed my own practice, I likely would have been less burned out and more efficient. Administrators were always getting in the way of that.
     
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  46. biscuitsbiscuits

    2+ Year Member

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    I don't know, if there's a way to significantly reduce overhead while maintaining patient care/confidentiality/ethics/etc, I think it's worth asking about. On off months (if you do such work that has "off months"), you could even skip the month with wework and save a month's worth of rent and utilities. The offices also look a lot better than a lot of psychologist offices I've seen (without cost of furniture, decor, etc.). Like I said, I'm not interested in PP myself. The idea just occurred to me and I was curious what those with experience would think.
     
  47. WisNeuro

    WisNeuro Board Certified Neuropsychologist
    Psychologist 7+ Year Member

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    Eh, it's no big deal. I know many people who do forensic and side therapy/assessment work through Regus offices. It can be a decent way to build up a referral base while you secure a standalone office or find other people to go into an office with you.
     
  48. smalltownpsych

    Psychologist 2+ Year Member

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    If you are good at what you do, then people will come see you in a closet. That being said, having a nice office does provide a little bit of an edge in securing a more motivated clientele. My experience has been that the second big factor after my own abilities is having solid support staff. That ends up helping both me and my patients which makes everyone happy and a happy office is more likely to be a profitable office. :cool:
     
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  49. CWard12213

    2+ Year Member

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    I've had a wide range of support staff quality and I think it might be the single biggest factor in my work quality of life. Great support staff can make your work life enjoyable. Poor support staff can make it hellish.
     

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