Selling a Cash Practice

[mgdsh]

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I'm in a position where I'm highly considering selling my practice as part of some changes in my personal life.

I've built up to 2+ days a week and its booked out several weeks. 100% of patients pay cash at time of service. Referrals continue to grow and could easily see this growing to 4 days a week with in a year. There's a strong online presence (currently with out any active advertising), strong referral base from other physicians and mental health colleagues.

I'm not necessarily looking to get a ton for it, but want to make sure my patients are taken care of and in good hands. Potential after overhead is 500k+. Currently bringing in approx 200k/yr on the above 2 days a week and growing.

Practice is ~35 min outside of San Francisco.

How would you go about selling your practice? Where would you list it? Any pitfalls to be aware of?

 

[F0nzie]

How about sharing a breakdown of what you are selling and how much you feel each product is worth and we can discuss?

 

[trophyhusband]

I'm in a position where I'm highly considering selling my practice as part of some changes in my personal life.

I've built up to 2+ days a week and its booked out several weeks. 100% of patients pay cash at time of service. Referrals continue to grow and could easily see this growing to 4 days a week with in a year. There's a strong online presence (currently with out any active advertising), strong referral base from other physicians and mental health colleagues.

I'm not necessarily looking to get a ton for it, but want to make sure my patients are taken care of and in good hands. Potential after overhead is 500k+. Currently bringing in approx 200k/yr on the above 2 days a week and growing.

Practice is ~35 min outside of San Francisco.

How would you go about selling your practice? Where would you list it? Any pitfalls to be aware of?

Someone offered to "sell" my wife their cash practice and our question was what exactly would she be buying? The patients aren't tied to the practice in anyway and can leave at any time. The referrers have no experience with my wife so there is no guarantee the referrals would continue. The physician didn't own the building so there were no physical assets outside of the office furniture.

My wife might have been interested in taking over the practice but buying it... no way. There's no reason that a new doc couldn't open up shop right next door and if the patients/referrers liked that person better the intangible stuff that was bought becomes useless.

Edit: All this is just to say that you're going to have to come up with a compelling reason for someone to pay you to take the practice off of your hands. The physician my wife was discussing her options with wasn't able to provide anything very compelling so it was a no go.

 

[vistaril]

I'm in a position where I'm highly considering selling my practice as part of some changes in my personal life.

I've built up to 2+ days a week and its booked out several weeks. 100% of patients pay cash at time of service. Referrals continue to grow and could easily see this growing to 4 days a week with in a year. There's a strong online presence (currently with out any active advertising), strong referral base from other physicians and mental health colleagues.

I'm not necessarily looking to get a ton for it, but want to make sure my patients are taken care of and in good hands. Potential after overhead is 500k+. Currently bringing in approx 200k/yr on the above 2 days a week and growing.

Practice is ~35 min outside of San Francisco.

How would you go about selling your practice? Where would you list it? Any pitfalls to be aware of?

Your practice is essentially worth whatever the physical contents of the practice is worth. No more. A psychiatry practice is not like a dental practice where there is some inherent value in the active patient list.

Assuming you don't own the building, if your office lease has a market value more than what you are tied into paying, that may be worth a little to a buyer if they can pick up the lease(although there might be something in the contract that the owner of the office can break, rendering it worthless).

Trying to get money here above those things is going to result in lots of frustration.

 

[vistaril]

My wife might have been interested in taking over the practice but buying it... no way. There's no reason that a new doc couldn't open up shop right next door and if the patients/referrers liked that person better the intangible stuff that was bought becomes useless.

Edit: All this is just to say that you're going to have to come up with a compelling reason for someone to pay you to take the practice off of your hands. The physician my wife was discussing her options with wasn't able to provide anything very compelling so it was a no go.

All of this is exactly correct.....the OP is in for a very rude awakening if he believes there is value in this practice outside the desks and chairs and stuff(outside of his actual service provided....which would of course leave with the practice)

 

[mgdsh]

Someone offered to "sell" my wife their cash practice and our question was what exactly would she be buying? The patients aren't tied to the practice in anyway and can leave at any time. The referrers have no experience with my wife so there is no guarantee the referrals would continue. The physician didn't own the building so there were no physical assets outside of the office furniture.

My wife might have been interested in taking over the practice but buying it... no way. There's no reason that a new doc couldn't open up shop right next door and if the patients/referrers liked that person better the intangible stuff that was bought becomes useless.

Edit: All this is just to say that you're going to have to come up with a compelling reason for someone to pay you to take the practice off of your hands. The physician my wife was discussing her options with wasn't able to provide anything very compelling so it was a no go.

You bring up some good points and I appreciate that.

You're right in that I don't own the building.

I do own the practice which had a custom build out, including sound proof walls. The office is fully furnished and those furnishings would come with it (sans my degrees on the wall). The practice has significant branding and name recognition through out the community and local providers. Alongside that is a website that now gets significant traffic on its own and brings in several referrals a week. The office is in a convenient location with well over 100k people with in the surrounding few miles with in business hours. Additionally, the website has online booking capabilities.

These are established patients, whom for a number of reasons (location convenience, hassle of finding a new provider, needing records transferred, etc) would remain on board. In addition I'd help with the transition in multiple areas from the business side, to maintaining provider relations and maintaining patient relations.

This is not an area where you can simply put up an office next door. There are very few to no suitable offices near by. In addition, if someone was to have found a suitable office, they'd pay a significant amount for a build out and office furnishings.

Opening a cash based practice was my dream in residency and in a way finding someone to take over would help me to continue to live that dream, knowing that the patients I worked with and the idea that I had were in good hands. For personal reasons, which I'm happy to disclose to anyone in serious consideration, I'm unable to continue to actively pursue that dream.

Given my above reasons I'm honestly not even looking to sell this for maximal value. I'd be okay with parting with the practice for less than 1 months net income.

 

[trophyhusband]

You bring up some good points and I appreciate that.

You're right in that I don't own the building.

I do own the practice which had a custom build out, including sound proof walls. The office is fully furnished and those furnishings would come with it (sans my degrees on the wall). The practice has significant branding and name recognition through out the community and local providers. Alongside that is a website that now gets significant traffic on its own and brings in several referrals a week. The office is in a convenient location with well over 100k people with in the surrounding few miles with in business hours. Additionally, the website has online booking capabilities.

These are established patients, whom for a number of reasons (location convenience, hassle of finding a new provider, needing records transferred, etc) would remain on board. In addition I'd help with the transition in multiple areas from the business side, to maintaining provider relations and maintaining patient relations.

This is not an area where you can simply put up an office next door. There are very few to no suitable offices near by. In addition, if someone was to have found a suitable office, they'd pay a significant amount for a build out and office furnishings.

Opening a cash based practice was my dream in residency and in a way finding someone to take over would help me to continue to live that dream, knowing that the patients I worked with and the idea that I had were in good hands. For personal reasons, which I'm happy to disclose to anyone in serious consideration, I'm unable to continue to actively pursue that dream.

Given my above reasons I'm honestly not even looking to sell this for maximal value. I'd be okay with parting with the practice for less than 1 months net income.

The items highlighted in green have real nominal value. I'd put a spreadsheet together that shows the $ value of those as it will only help your cause.

The item in red doesn't have much value at all unfortunately. The branding is you as you are the sole provider (my assumption) once you leave that value is gone. Also, your assumption that the patients will stay shouldn't be taken at face value by anyone hoping to purchase your practice. The person who takes over could have a very different personality and they might not click with the patients. The patients might stick around for the transition period while you're helping out and then leave immediately afterward. The same could be said for the referral sources.

The items in blue might have some value. If the practice is named after you then the website probably isn't worth anything but if it's a more general name then it could have some value as new patients won't know any different once the change over happens. Office convenience might have a very slight value but the new person will be paying the lease so they're already paying for the convenience and surroundings... it's just the payment is going to the landlord and not you. If you believe you have a below market lease rate try to quantify that as it might help as well (it's only valuable for as long as the lease runs so don't try to show it going on into perpetuity).

At least you're being somewhat reasonable with what you're asking (I'm assuming $200k/12 based on your first post). It really depends on what the value of the items in green truly ends up being and if anything in blue can be quantified. If my wife were still looking she might have wanted to talk to you.

Anyway, I've seen practice for sale ads in Psychiatric Times on occasion. Heck you might get a few folks just from posting this on SDN. Best of luck.

 

[mgdsh]

The items highlighted in green have real nominal value. I'd put a spreadsheet together that shows the $ value of those as it will only help your cause.

The item in red doesn't have much value at all unfortunately. The branding is you as you are the sole provider (my assumption) once you leave that value is gone. Also, your assumption that the patients will stay shouldn't be taken at face value by anyone hoping to purchase your practice. The person who takes over could have a very different personality and they might not click with the patients. The patients might stick around for the transition period while you're helping out and then leave immediately afterward. The same could be said for the referral sources.

The items in blue might have some value. If the practice is named after you then the website probably isn't worth anything but if it's a more general name then it could have some value as new patients won't know any different once the change over happens. Office convenience might have a very slight value but the new person will be paying the lease so they're already paying for the convenience and surroundings... it's just the payment is going to the landlord and not you. If you believe you have a below market lease rate try to quantify that as it might help as well (it's only valuable for as long as the lease runs so don't try to show it going on into perpetuity).

At least you're being somewhat reasonable with what you're asking (I'm assuming $200k/12 based on your first post). It really depends on what the value of the items in green truly ends up being and if anything in blue can be quantified. If my wife were still looking she might have wanted to talk to you.

Anyway, I've seen practice for sale ads in Psychiatric Times on occasion. Heck you might get a few folks just from posting this on SDN. Best of luck.

Thank you 🙂 Practice name isn't my [Full Name, MD] so the branding should still work.

Could definitely put together a spread sheet and anyone interested would see that they are essentially paying for the physical items, build out, website and getting them at a significantly reduced cost to what I put in. The patients have 0 value and are being treated as such in my ideal selling price.

 

[vistaril]

You bring up some good points and I appreciate that.

You're right in that I don't own the building.

I do own the practice which had a custom build out, including sound proof walls. The office is fully furnished and those furnishings would come with it (sans my degrees on the wall). The practice has significant branding and name recognition through out the community and local providers. Alongside that is a website that now gets significant traffic on its own and brings in several referrals a week. The office is in a convenient location with well over 100k people with in the surrounding few miles with in business hours. Additionally, the website has online booking capabilities.

These are established patients, whom for a number of reasons (location convenience, hassle of finding a new provider, needing records transferred, etc) would remain on board. In addition I'd help with the transition in multiple areas from the business side, to maintaining provider relations and maintaining patient relations.

This is not an area where you can simply put up an office next door. There are very few to no suitable offices near by. In addition, if someone was to have found a suitable office, they'd pay a significant amount for a build out and office furnishings.

Opening a cash based practice was my dream in residency and in a way finding someone to take over would help me to continue to live that dream, knowing that the patients I worked with and the idea that I had were in good hands. For personal reasons, which I'm happy to disclose to anyone in serious consideration, I'm unable to continue to actively pursue that dream.

Given my above reasons I'm honestly not even looking to sell this for maximal value. I'd be okay with parting with the practice for less than 1 months net income.

dude, you need to PUT DOWN THE HASHISH PIPE. There is so much bs floating through the entirety of this post that even a completely clueless buyer is going to see right through it.

1) you don't own the building as you said. Given that this is outside san fran, the thing of great value here is the building....which you don't own. Given this however, we need to look at the lease? Is it a good lease(ie you pay less than market value?) that the new owner of this lease can continue in? If so, that does have value....regardless of whether you sell to a psychiatrist or a Chinese food vendor.

2) You rambling on about the great location goes towards point 1....you DONT OWN the building. That's a great selling point for the owner of the building when he is ready to sell. You are doing a bang up job marketing towards him.
3) The 'significant branding'(if true) this practice has is all related to you. I know many on here think I bash psychiatry, but if you actually believe cash pay psychiatry is so commoditized that you can simply transfer cash pay providers like this and branding stays the same, you're insane. That's the ultimate bash against our field.

4) You have no idea how many of these cash pay patients would stay on board. There are gobs of cash pay psychiatrists in that area.

5) Your office furnishings have value....almost certainly much less value than you paid for them, but still actual value. You may get 15 cents on the dollar for it.



It really comes down to the lease. If your lease is below market value and the owner of the building cant get out of it when transferred(read the language carefully....I bet this is possible) than that's where the value of the practice is. And it has nothing to do with it being a psychiatry practice. If you were selling dog treats and had a good transferable lease, still the same value. But if there is no value in the lease itself you are probably going to lose money even 'transferring' this practice. If you are lucky you may break even.

 

[vistaril]

At least you're being somewhat reasonable with what you're asking (I'm assuming $200k/12 based on your first post). .

of if that's the kind of $ he is looking for, it may be reasonable depending on how nice the office furniture and 'build out' is. that's less than newly used Honda civic cost for Christ sake. In that case, he should change the name of the question to - "I'm looking to get back some of the money I put into an office buildout and furniture....best way to do that?" and drop the phrase 'sell the practice'.

 

[trophyhusband]

of if that's the kind of $ he is looking for, it may be reasonable depending on how nice the office furniture and 'build out' is. that's less than newly used Honda civic cost for Christ sake. In that case, he should change the name of the question to - "I'm looking to get back some of the money I put into an office buildout and furniture....best way to do that?" and drop the phrase 'sell the practice'.

Yep, but as you said in your post and I should have said in mine check your lease. If the landlord can opt out of the lease upon transfer the leaseholder improvements have no real value. This all ties into whether the lease is naturally below market and then even further below market after the improvements are taken into account. Anyway, this person isn't asking over $100k like the person my wife was talking to which was just pie in the sky craziness.

 

[vistaril]

Yep, but as you said in your post and I should have said in mine check your lease. If the landlord can opt out of the lease upon transfer the leaseholder improvements have no real value. This all ties into whether the lease is naturally below market and then even further below market after the improvements are taken into account. Anyway, this person isn't asking over $100k like the person my wife was talking to which was just pie in the sky craziness.

one exception for 'selling a practice' though where other such value exists if it there are contracts with a hospital system that have value and can be transferred(this usually applies to inpatient). For example, if a group has exclusive admitting priv to a high volume inpatient unit. If that exclusive contract results in a guaranteed financial windfall(they rarely do), that's another thing you can cash in on.

 

[mgdsh]

Hadn't seen vistarils comments until it looked like trophyhusband was commenting to himself.

Great points (I never thought I'd be saying that to vistaril). Yes, included is a lead generation service, below market rent which the landlord is agreeable to transferring and a contract for referrals from a large health system.

 

[vistaril]

Hadn't seen vistarils comments until it looked like trophyhusband was commenting to himself.

Great points (I never thought I'd be saying that to vistaril). Yes, included is a lead generation service, below market rent which the landlord is agreeable to transferring and a contract for referrals from a large health system.

just curious- how does a contract for cash pay referrals even work? I've just never heard of such a referral contract for cash pay services(ie "not only must you go here but you also must pay cash")

 

[mgdsh]

just curious- how does a contract for cash pay referrals even work? I've just never heard of such a referral contract for cash pay services(ie "not only must you go here but you also must pay cash")

They understand its an out of network referral. There's no shortage of $$ here. Many of my patients are multimillionaires and would rather have convenience, good care and accessibility. Patients understand they have the option of submitting a superbill with PPO insurances. This is a busy area in which time and health are worth more than money. If patients don't have money often family members or other relatives do.

 

[vistaril]

They understand its an out of network referral. There's no shortage of $$ here. Many of my patients are multimillionaires and would rather have convenience, good care and accessibility. Patients understand they have the option of submitting a superbill with PPO insurances. This is a busy area in which time and health are worth more than money. If patients don't have money often family members or other relatives do.

I get that, but how is it a referral 'contract' then? It doesn't sound like it could be exclusively enforced is what I'm getting at, so I don't know if the term contract is appropriate. It sounds like you and them have an understanding that they will tell their patients only about your group in terms of options, but I wouldn't call that a contract. More like you've developed good rapport/relationship with this health system and they send cash patients your way for now, but legally that's an important distinction.

 

[Indodo]

I'm in a position where I'm highly considering selling my practice as part of some changes in my personal life.

I've built up to 2+ days a week and its booked out several weeks. 100% of patients pay cash at time of service. Referrals continue to grow and could easily see this growing to 4 days a week with in a year. There's a strong online presence (currently with out any active advertising), strong referral base from other physicians and mental health colleagues.

I'm not necessarily looking to get a ton for it, but want to make sure my patients are taken care of and in good hands. Potential after overhead is 500k+. Currently bringing in approx 200k/yr on the above 2 days a week and growing.

Practice is ~35 min outside of San Francisco.

How would you go about selling your practice? Where would you list it? Any pitfalls to be aware of?

Your assets here are your physical assets and possibly the web traffic/lead generation and this contract for referrals.
Your lease, even if it is below market value, is actually a liability.
You patient records are a liability. BTW, are you electronic or paper?

There are a lot of psychiatrists in the bay area although compared to other specialties, still not as saturated but its not like cash patients are going to have a hard time finding a new psychiatrist.

The biggest impediment you may have is, can you get out of the lease and if not, how many years do you have remaining on the lease.

 

[Indodo]

Another thing, I don't think I have agree with vistaril so many times in a row. 😱

 

[trophyhusband]

Your lease, even if it is below market value, is actually a liability.

Of course but it's a liability that can have value much like a rent controlled apartment has value even though the lease is a liability. Really depends on how hard it is to rent an office in the area where the OP's office resides. It's also something that the OP is going to have to research and spend time quantifying.

Edit: It also depends on how much someone wants to buy the practice/work in that area. If no one wants it then it's just a pure liability.

 

[TexasPhysician]

I think 50k would be a possibility assuming the build-out is ideal for the new person, the lease is good, the office furniture is ideal, and that a certain percentage of patients stay over 3-6 months. If more patients leave, the buy-out drops by x amount. The key as others have mentioned is that patients can always leave when you leave hence that is only an asset if most stay. Have the buy-out as being flexible based on retention and you may find a buyer

 

[Leo Aquarius]

 

[PikminOC]

So after 200k and you take out taxes and overhead, you are willing to sell for 10K?

 

[mgdsh]

I think 50k would be a possibility assuming the build-out is ideal for the new person, the lease is good, the office furniture is ideal, and that a certain percentage of patients stay over 3-6 months. If more patients leave, the buy-out drops by x amount. The key as others have mentioned is that patients can always leave when you leave hence that is only an asset if most stay. Have the buy-out as being flexible based on retention and you may find a buyer

Honestly I'm looking for a 1/4 of that. Why? To me its more important to find the right person. I've made a number of great decisions investment wise and that's put me in a place that I don't have to maximize this. There are patients involved and for that reason it's much more important to me to find the right person. Money has never been the most important thing to me and it certainly isn't now.

Also, I should add, just as a tidbit. That it's unethical to pay for referrals or have compensation tied to referrals or say what % of patients stay.

Finally, with the price I'm looking for, it's much along the lines of what a psychiatrist would pay in start up costs from build out to furniture and website alone. This just happens to include many extras and is the ideal situation for someone looking to get into a cash only practice.

 

[splik]

Also, I should add, just as a tidbit. That it's unethical to pay for referrals or have compensation tied to referrals or say what % of patients stay.

for medicare and medicaid patients it's actually illegal - see Stark law

 

[TexasPhysician]

Also, I should add, just as a tidbit. That it's unethical to pay for referrals or have compensation tied to referrals or say what % of patients stay.

It's illegal to pay based on percentage that stay in a cash practice? If so, the patients have 0 value when selling.

While it is illegal to pay or receive payment for referrals, is there a clause that includes sales of practices that doesn't include Medicare/Medicaid?

If you aren't trying to maximize your return on the sale, offer the practice for free to the best applicant to fulfill your patients needs.

 

[mgdsh]

for medicare and medicaid patients it's actually illegal - see Stark law

Thanks for the clarification.

 

[mgdsh]

It's illegal to pay based on percentage that stay in a cash practice? If so, the patients have 0 value when selling.

While it is illegal to pay or receive payment for referrals, is there a clause that includes sales of practices that doesn't include Medicare/Medicaid?

If you aren't trying to maximize your return on the sale, offer the practice for free to the best applicant to fulfill your patients needs.

I do want to make sure there is a reasonable price. I could in theory offer it for free, but I want to make sure the person taking over is invested in going down this route. If I was to give away the practice for free, what's to stop someone from say selling/flipping the furniture for several $k?

As you suggested above its something that could command a significant dollar amount, but as I'll reiterate again, that is not important to me. I'm not looking to make a killing or even my initial investment back. That's already been done many many fold over. I'm in a very fortunate place in my life right now and it's important to me make sure the right person is taking over.

I'm a 7+ year member on this site, not someone who created their account today 🙂 I hold a very high regard for most of my colleagues on this very forum. I'm typically a silent lurker but I've learned a lot over the years here, including in this very thread. Starting a cash practice isn't easy, from the upfront costs, planning and timeline. That doesn't even include building up to a steady stream of patients. I believe what I'm offering is at a similar or even cheaper start up cost while virtually ensuring that there is a steady stream of patients early on.

 

[PikminOC]

I do want to make sure there is a reasonable price. I could in theory offer it for free, but I want to make sure the person taking over is invested in going down this route. If I was to give away the practice for free, what's to stop someone from say selling/flipping the furniture for several $k?

As you suggested above its something that could command a significant dollar amount, but as I'll reiterate again, that is not important to me. I'm not looking to make a killing or even my initial investment back. That's already been done many many fold over. I'm in a very fortunate place in my life right now and it's important to me make sure the right person is taking over.

I'm a 7+ year member on this site, not someone who created their account today 🙂 I hold a very high regard for most of my colleagues on this very forum. I'm typically a silent lurker but I've learned a lot over the years here, including in this very thread. Starting a cash practice isn't easy, from the upfront costs, planning and timeline. That doesn't even include building up to a steady stream of patients. I believe what I'm offering is at a similar or even cheaper start up cost while virtually ensuring that there is a steady stream of patients early on.

I thank you for posting this. Many great comments here.
It's obvious you care about your patients.
The other days does anyone else use your room?
Any staff?

 

[mgdsh]

I thank you for posting this. Many great comments here.
It's obvious you care about your patients.
The other days does anyone else use your room?
Any staff?

No one else uses the office. No staff at present, but hiring a secretary would be relatively easy for $15-20/hr.

 

[TexasPhysician]

I do want to make sure there is a reasonable price. I could in theory offer it for free, but I want to make sure the person taking over is invested in going down this route. If I was to give away the practice for free, what's to stop someone from say selling/flipping the furniture for several $k?
.

You think someone will sign contracts to take over a lease and be custodian of all your charts for a few hundred in used furniture? Where are these desperate psychiatrists? I've got a clinic willing to hire them.

 

[mgdsh]

You think someone will sign contracts to take over a lease and be custodian of all your charts for a few hundred in used furniture? Where are these desperate psychiatrists? I've got a clinic willing to hire them.

Mind if I ask what part of Texas? I personally wouldn't consider a job outside of California unless it started with 7 figures. Austin is one rare exception to that.

 

[clusterF]

You say that you are making 200k currently in 2 days? How many hours per day and how much time do you spend on the practice outside those 2 days?
Is that before or after overhead? Do you have a secretary, EMR, answering service?

Also, what are you doing the other days if you are booked out for several weeks?

 

[mgdsh]

You say that you are making 200k currently in 2 days? How many hours per day and how much time do you spend on the practice outside those 2 days?
Is that before or after overhead? Do you have a secretary, EMR, answering service?

Also, what are you doing the other days if you are booked out for several weeks?

After overhead. Contract at other locations on other days. Spend a few hours outside those 2 days returning calls to setup appointments etc. Don't presently have a secretary. Had planned on hiring one later this year. No EMR as that slows you down and gets in the way of you and your patients. No answering service.

 

[Indodo]

LOL.

 

[mgdsh]

Not quite sure what's so funny. It's what works for me. Most of those details are minor and can be easily changed. Patients are rather low maintenance. I'm still yet to get a call in the middle of the night.

 

[clusterF]

After overhead. Contract at other locations on other days. Spend a few hours outside those 2 days returning calls to setup appointments etc. Don't presently have a secretary. Had planned on hiring one later this year. No EMR as that slows you down and gets in the way of you and your patients. No answering service.

You are booked out for "several weeks" and yet you contract at other days. Would you care to explain why? Based on your numbers you are making about 250k per hour. I don't know of any contract jobs that pay that much. Not only that, you would have the benefit of growing your business and being your own boss etc.

Something doesn't add up.

 

[mgdsh]

You are booked out for "several weeks" and yet you contract at other days. Would you care to explain why? Based on your numbers you are making about 250k per hour. I don't know of any contract jobs that pay that much. Not only that, you would have the benefit of growing your business and being your own boss etc.

Something doesn't add up.

Contracting actually pays relatively well. Anyone who has built up a cash practice will tell you that they'll wait for the practice to get to this point before trading days. I would be doing that here in very short order if not already but for the personal reasons (as mentioned in original pos) that have come up. Anyhow, I've think I've found the transition I'm looking for.

 

[PikminOC]

Contracting actually pays relatively well. Anyone who has built up a cash practice will tell you that they'll wait for the practice to get to this point before trading days. I would be doing that here in very short order if not already but for the personal reasons (as mentioned in original pos) that have come up. Anyhow, I've think I've found the transition I'm looking for.

Any info you are willing to share would be helpful to us docs who really don't know much about private practice.
Trading days?

 

[mgdsh]

Any info you are willing to share would be helpful to us docs who really don't know much about private practice.
Trading days?

Trading days in this sense would be swapping in another day at the cash practice and consulting one fewer day.

Feel free to ask away. I'm very grateful to many members on this forum.

 

[clusterF]

Contracting actually pays relatively well. Anyone who has built up a cash practice will tell you that they'll wait for the practice to get to this point before trading days. I would be doing that here in very short order if not already but for the personal reasons (as mentioned in original pos) that have come up. Anyhow, I've think I've found the transition I'm looking for.

I have built up a practice. I didn't wait till I was booked out several weeks before adding days because adding days also adds to the business because it lends flexibility. I don't disagree with your numbers and how much you can earn per day, I disagree with why you would still contract 3 days when you are so busy in your 2 days of practice.

I'm also not saying contracting pays poorly. I'm saying it pays a lot less than the 250k per hour you are claiming, after overhead, for your private practice. A lot less. It's very hard to find anything higher than 150 without going to a prison in the bay area. But even the prisons in california don't pay anywhere close to 250k. The major players are the counties, TBH, jails and prisons in the bay area. I know this area well. I know the contract rates also.

I'm happy for you in that you found your transition. Maybe it's a good fit, lets hope so but then again there is a sucker born every minute. However, I think your posts were at least a little and possibly very misleading.

 

[PikminOC]

Trading days in this sense would be swapping in another day at the cash practice and consulting one fewer day.

Feel free to ask away. I'm very grateful to many members on this forum.

What is contracting and consulting in psychiatry?

 

[mgdsh]

I have built up a practice. I didn't wait till I was booked out several weeks before adding days because adding days also adds to the business because it lends flexibility. I don't disagree with your numbers and how much you can earn per day, I disagree with why you would still contract 3 days when you are so busy in your 2 days of practice.

I'm also not saying contracting pays poorly. I'm saying it pays a lot less than the 250k per hour you are claiming, after overhead, for your private practice. A lot less. It's very hard to find anything higher than 150 without going to a prison in the bay area. But even the prisons in california don't pay anywhere close to 250k. The major players are the counties, TBH, jails and prisons in the bay area. I know this area well. I know the contract rates also.

I'm happy for you in that you found your transition. Maybe it's a good fit, lets hope so but then again there is a sucker born every minute. However, I think your posts were at least a little and possibly very misleading.

Seems that you've misread something and stated it several times. I've never said I was making 250k per hour.

I said my income after overhead was 200k for 2 days a week at the practice. I'll also restate as I did in the prior post, that had it not been for personal reasons that have come up I would be expanding to 3 days a week.

Also there's a huge difference between building up an all cash practice and one that takes insurance. I've never been on a single panel and never will be 🙂

This is an open public forum, which limits the amount of information that I can share. I can assure you though, nothing in my thread here has been misleading. I didn't just sign up this week or this month. I've been a member of this forum for over 7 years now.

Hi,

So I took a job out of residency at a county part time while trying to build a cash practice. This isn't going so well. Mostly because everyone wants to use insurance. I have now tried to get on insurance plans and almost everyone wants me to be on staff at a hospital. Although I am staff at the county hospital, that doesn't count because they don't take private insurance.
I have medicare but there really isn't a lot of medicare. There is tons of tricare but that is also difficult because they are being managed by united.

Any ideas? Or do i just call a local hospital and try to get privileges?

Thanks for your help.
Wish I had just taken that job with Kaiser.

I hope things have gotten dramatically better for you in the last year.

 

[mgdsh]

What is contracting and consulting in psychiatry?

Both of those should have read contracting.

 

[clusterF]

Seems that you've misread something and stated it several times. I've never said I was making 250k per hour.

I said my income after overhead was 200k for 2 days a week at the practice. I'll also restate as I did in the prior post, that had it not been for personal reasons that have come up I would be expanding to 3 days a week.

Also there's a huge difference between building up an all cash practice and one that takes insurance. I've never been on a single panel and never will be 🙂

This is an open public forum, which limits the amount of information that I can share. I can assure you though, nothing in my thread here has been misleading. I didn't just sign up this week or this month. I've been a member of this forum for over 7 years now.

200k in 2 days days is 250k per hour for those days unless you are working more than a normal 8 hour day. If you are making this money working 10, 12, 14 hour days you should disclose that because either you are misleading or you are simply bad at math.

All your other info is fluff and largely meaningless. Nobody is asking you to share anything specific and I doubt people care. However, if you want to put an ad up, you should expect questions. Your 7 years is great but I think you overestimate it's relevance as you keep posting it. Good for you but it doesn't mean that you cannot be deceptive.

I hope things have gotten dramatically better for you in the last year.

Thanks for your concern. I don't know what would be considered dramatic in your case but I am doing a lot better. In fact this is what concerns me about your posts. I am relatively new out of residency and have almost a full practice that is cash and insurance. However, the point is that you indicate your practice is booming and it clearly is not. I am working 5 days in private practice now and although I am not booked for "several weeks" or even 100% full, I still make more than any contract job.

For someone that is as experienced as you claim to be and have a 2 day practice that is "booked for weeks" and "continues to grow" "without any active advertising" yet continue to work contract jobs for 3 days is hard to stomach. You would have gone and had some lunches with some pcps or even called them about current patients and your referrals would have grown even more. I could understand if you were not growing that fast for whatever reason but to give the impression that you were packed on your private days, making 100k per day/per year and still taking 3 days of contract. Balderdash!

Fantastic misdirection BTW. Anything else?

 

[mgdsh]

Absolutely no misdirection, but please continue to believe what you'd like.

Speaking of misleading, you claim to be an expect on cash practices but are dependent on insurance and I'm guessing a large % of your income comes from insurance.

 

[hamstergang]

200k in 2 days days is 250k per hour for those days unless you are working more than a normal 8 hour day.

Can we just clarify that you mean $250 per hour, not 250k per hour, which you keep saying but is clearly ridiculous.

 

[OldPsychDoc]

Can we just clarify that you mean $250 per hour, not 250k per hour, which you keep saying but is clearly ridiculous.

Unless you're an NBA player.

 

[PikminOC]

Can we just clarify that you mean $250 per hour, not 250k per hour, which you keep saying but is clearly ridiculous.

Not ridiculous if you are Tony Robbins...

 

[PikminOC]

So contracting means working for somewhere else, like locums, the rest of the time? Why not keep doing the cash practice more days? Or do you get benefits at the contracting job?

 

[Indodo]

So contracting means working for somewhere else, like locums, the rest of the time? Why not keep doing the cash practice more days? Or do you get benefits at the contracting job?

No, in most cases it is because there aren't enough patients. He isn't busy enough to have more than 2 days so the contract work supplies a steady income.