Starting Up Private Practice...

[psychresident14]

Hi fellow SDNers,

I'm potentially thinking about joining a private practice in the Northwest. My pay would be proportional to the amount of patients I bring in and see. It seems like a rather significant risk for me since I'm currently in the Midwest and with the amount of loans I have, wondering how much in the zero I would have to be to actually be bringing in a decent salary. The potential partner tells me that he'll try to spread my name to two universities, some PCPs, possibly other psychiatrists. I know my question is pretty broad but how long does it typically take to build a 35-40 patient hours a week practice and what should I be considering? When do the risks outweigh the benefits and vice versa? Would appreciate any advice. Thanks.

Also, patient population that the practice is considering would mainly be just mood disorders, no psychosis/substance abuse, with insurance, no Medicare/medicare, no frequent fliers to the inpatient.

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[slappy]

Hi fellow SDNers,

I'm potentially thinking about joining a private practice in the Northwest. My pay would be proportional to the amount of patients I bring in and see. It seems like a rather significant risk for me since I'm currently in the Midwest and with the amount of loans I have, wondering how much in the zero I would have to be to actually be bringing in a decent salary. The potential partner tells me that he'll try to spread my name to two universities, some PCPs, possibly other psychiatrists. I know my question is pretty broad but how long does it typically take to build a 35-40 patient hours a week practice and what should I be considering? When do the risks outweigh the benefits and vice versa? Would appreciate any advice. Thanks.

Also, patient population that the practice is considering would mainly be just mood disorders, no psychosis/substance abuse, with insurance, no Medicare/medicare, no frequent fliers to the inpatient.

What percentage of the gross income would be your take-home? Would you be a W-2 employee or a partner (i.e. from where will the taxes be taken)? Is this an established practice or a brand new one? What's the no-show policy for the clinic? Therapy or med-management or both?

 

[psychresident14]

What percentage of the gross income would be your take-home? Would you be a W-2 employee or a partner (i.e. from where will the taxes be taken)? Is this an established practice or a brand new one? What's the no-show policy for the clinic? Therapy or med-management or both?

- I'm not sure what the percentage would be, but 35 patient hour practice a week practice would pay $260,000 a year with $40,000 end of year bonus. Would see 1-2 new patients a day for 60 minutes. Would see 30 minute follow-ups.
- W-2 employee.
- Established one man practice.
- No show policy: I believe needs to have at least 24 hour notice. If not, would be charged for their visit if cannot fill slot with another patient.
- Both therapy and med-management in the 60 minute/30 minute appointments.

Thanks!

 

[splik]

- Both therapy and med-management in the 60 minute/30 minute appointments.

um how exactly? they are definitely not paying you to do psychotherapy if your f/us are 30mins!

If your paneled with a wide range of insurance companies you should expect to fill quite quickly! Though if you are only seeing 1-2 new patients a day and not going to see follow ups established in the system, it would take you about a year to fill a med management practice with high functioning patients. It does not make sense to see so few new pts when establishing a new cases load if you are not inheriting a case load.

 

[psychresident14]

Yeah not necessarily FORMAL therapy. Just supportive I guess or how normal conversations can be therapy to patients ha.

 

[psychresident14]

Midwest state I am now typically does 15 minute med management in PP and other community settings so 30 minutes sounds like a decent amount of time to spend with follow up patients.

 

[splik]

i think you missed the point. he was asking if you were doing therapy because if you were actually seeing patients for psychotherapy you would fill far quicker because you would need fewer patients.

 

[psychresident14]

Sorry, then my answer is no. I wouldn't really be seeing patients for therapy only.

 

[slappy]

- I'm not sure what the percentage would be, but 35 patient hour practice a week practice would pay $260,000 a year with $40,000 end of year bonus. Would see 1-2 new patients a day for 60 minutes. Would see 30 minute follow-ups.
- W-2 employee.
- Established one man practice.
- No show policy: I believe needs to have at least 24 hour notice. If not, would be charged for their visit if cannot fill slot with another patient.
- Both therapy and med-management in the 60 minute/30 minute appointments.

Thanks!

Plenty of good responses in the thread already. It would make a lot of sense for you to see a lot more new patients initially (as you're unlikely to have much spillover from a one-man practice), and have monthly follow-ups for most of your intakes at least for a short while. Yes, you would be filling more follow-up slots this way, but more importantly (yes, more importantly), you'll build a good relationship with your patients. With higher functioning clientele, relationships and word-of-mouth will go a long way, especially in a new city. Unfortunately, I don't know of anyone who has signed a contract like that so it's hard to say (most people I know who went with a similar model had 80/20 or 75/25 cuts after expenses) so it's hard for me to say exactly how long it'll take for you to compensate for the initial losses (compared to someone who takes up a position with a fixed salary). No medicare/medicaid is probably going to make it slower, but I know a fair few who filled up their 40-hour practices within 4-6 months (but, this is the east coast; the only person I know who took up a private practice position in the midwest filled in less than 2 months but she's a CAP so it's not a fair comparison, although it should theoretically be easier to fill in the midwest). All that to say, you're going to be just fine. Good luck.

 

[F0nzie]

- I'm not sure what the percentage would be, but 35 patient hour practice a week practice would pay $260,000 a year with $40,000 end of year bonus. Would see 1-2 new patients a day for 60 minutes. Would see 30 minute follow-ups.
- W-2 employee.
- Established one man practice.
- No show policy: I believe needs to have at least 24 hour notice. If not, would be charged for their visit if cannot fill slot with another patient.
- Both therapy and med-management in the 60 minute/30 minute appointments.

Thanks!

You would not receive a guaranteed salary and you do not know the percentages? If there is any risk here it is because you are trying to make a business decision blindfolded. What is the collections rate? Don't get seduced by how much you could earn or words like bonus in a business deal-- you need to get the facts.


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[Shikima]

I'd be careful of this arrangement. Appears that he'll be cherry picking cases and you'll get the leftovers.

 

[psychresident14]

Thanks for all your input... Definitely superficially sounds great but based on your guys' recs, I'm definitely more reluctant about the opportunity now. Very helpful! THANKS!

 

[Merovinge]

Thanks for all your input... Definitely superficially sounds great but based on your guys' recs, I'm definitely more reluctant about the opportunity now. Very helpful! THANKS!

This is quite the rage I've seen in the midwest. Older groups of 1 to sometimes a 1/2 dozen providers go to career fair or try to get their names out to graduating fellows. They offer pretty terrible splits (60/40, maybe 70/30) with the added benefit of having someone new to dump undesirable patients on. The get pretty good reinbursement from the insurance companies they accept so the deal sounds good to a graduating fellow.

 

[finalpsychyear]

Thanks for all your input... Definitely superficially sounds great but based on your guys' recs, I'm definitely more reluctant about the opportunity now. Very helpful! THANKS!

Part time side job + rent a room from a group PCP office and your golden. This is how I should have done it but it worked out all the same.