The business side of Psych

[DD214_DOC]

I'm still interested in Psychiatry, and had a few questions.

What sort of revenue would a decent practice generate? Say, with 1-2 providers (maybe a MD/DO and a PsyD/PhD) and some other staff? What role would a psych nurse play in a pvt practice? Are they actually necessary? How are most practices setup?

Any info would be appreciated. I'm really interested in the business aspect of medicine and am looking to see which of my specialty interests match well with entrepreneurship.

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[NeuroDO]

I'm still interested in Psychiatry, and had a few questions.

What sort of revenue would a decent practice generate? Say, with 1-2 providers (maybe a MD/DO and a PsyD/PhD) and some other staff? What role would a psych nurse play in a pvt practice? Are they actually necessary? How are most practices setup?

Any info would be appreciated. I'm really interested in the business aspect of medicine and am looking to see which of my specialty interests match well with entrepreneurship.

It depends on what type of practice you want to have. If you want to do 15 minute medication managment visits, you'll need a receptionist to manage your practice. You can make good money since you're seeing 4 patients an hour.

I'm probably going to be seeking psychoanaytic training, and plan on 50 minute sessions, fee for service, at $250 to $300 per session. If you have insurance, you have to file it yourself. I'll provide you with a bill. Many psychiatrist in major metropolitan areas (such an Manhattan) practice this way and have plenty of demand and patient volume. However, if you want to do this, you have to practice in a major metropolitan area. While you don't really need an receptionist in this type of practice, you'll have to do all your phone calls/appointment making and billing yourself. Also, keep in mind, you're going to have high overhead for office space in areas for this type of practice. Not to mention the taxes you have to pay in places like New York City or Connecticut. The advantage of this model of practice is that you really get to treat your patients, since you're seeing them for 50 minutes one or more times a week. The disadvantage is that many needy patients won't be able to afford to see you. Many high end psychiatrists offer reduced fees for individuals with financial need who want and are in need of in depth psychiatric services and/or psychoanalysis.

PhDs/PsyD in Manhattan generally charge from $125 to $175 and some are higher. Most all of them handle their own phone calls, appointments, and billing much the same as the psychiatic practice described above. Most also offer reduced fees for those who are unable to afford their services are are in serious need.

While these rates might seem high to people in middle America, keep in mind a one bedroom apartment in Manhattan costs upwards of $2000 to $2500 a month. The fees charged are comparable to the high cost of living. I'm only discussing the fee structures and practice setups of the few practices with which I am familiar, and they are certainly not representative of most psychiatric practices in America that have to deal with insurance and managed care.

 

[worriedwell]

Well lets see here...at 250/hr, if you see 6 patients per day, and do fee for service (you can get away with this in manhattan). Thats $1500 per day. If you work 5 days a week, thats $7500 per week. If you work 40 weeks out of the year (hey, maybe you like to take summers off-although your patients probably wouldn't keep coming to you if you didn't see them for a whole 3 months straight...or maybe you only like to work three weeks a month or something, I'm being conservative). Then that amounts to $300,000 per year.

250/hr x 6hrs x 5days x 40wks = $300,000/yr. (gross income)

That is some serious bank for not a lot of work. Granted this is a manhattan psychoanalyst model, which essentially is tough to match in any other city and is offset by high cost of living, but still impressive bang for the buck. Also, be aware that being a psychoanalyst is a heavy time and money investment that takes usually 4 years of intensive training after residency to complete. Also, your office overhead is your only expense which might cost like 25,000/yr. No receptionists or other staff at all, which is in stark contrast to other medical professions where they pay for equipment and staff.

Also, be aware that in takes tremendous patience to be an analyst and it is not for everyone. It can be a grueling, exhausting 6 hour work day and doing this type of practice can be professionally isolating as well. But economically, some people are surprised that a psychiatrist (if they sell out so to speak) can do quite well without a lot of overhead or hours.

 

[PublicHealth]

'm probably going to be seeking psychoanaytic training, and plan on 50 minute sessions, fee for service, at $250 to $300 per session. If you have insurance, you have to file it yourself. I'll provide you with a bill. Many psychiatrist in major metropolitan areas (such an Manhattan) practice this way and have plenty of demand and patient volume.

Fascinating. Are you a DO? Where are you in school/residency? An osteopathic psychoanalyst! I'd love to hear about your background. Very intriguing.

 

[DD214_DOC]

What exactly is the post-residency training in psychoanalysis?

 

[bth7]

To do post-residency training in psychoanalysis is a serious undertaking. You do this at one of the many Psychoanalytic institutes across the county. There are places that do more classic pschyoanalysis (based on Freud's ideas) and places that do more Jung style analysis.

The first, almost universal requirement is to be in anaylsis yourself for at least a couple of years with one analyst, BEFORE entering such a program and then certainly for the length of the training program. Anaylsis is such a personal, intimate encounter - only someone who has thoroughly analyzed themselves could hope to engage other people in the process. Bear in mind that just being in analysis yourself is a very expensive undertaking and a very serious commitment.

They also require that you have been licensed and seeing patients in some capacity for several years. If you've done a resisdency in psych, this usually fufills this. But note, the VAST majority of psychoanalysts are NOT physicians. Probably b/c you simply don't need to be.

Also note, there's some confusion about terms. Psychotherapy and Psychoanalysis are two very distinct things. Any mental health professional could be called a psychotherapist. Psychoanalysis is a very specific, very involved type of psychotherapy.

For more try these links to two major institutes training info pages:

SF Jung Institute

NY Psychoanalysis

They both give info on their training programs in detail.

 

[gaki]

I just heard from one I talked to that it would be a good idea to work for a clinic or hospital for awhile, to build up a good local reputation first, and make contacts, before going into private practice. He also said that when you open up your practice, especially if you are not working at another place at the same time, that it is a good idea to have enough saved up to support yourself for at least a year, while you build up your client list to fill your workday with.

That is just some advice I got from one psychiatrist, who worked in Cali and Hawaii.

Im sure it varies depending on where you live.

I'm still interested in Psychiatry, and had a few questions.

What sort of revenue would a decent practice generate? Say, with 1-2 providers (maybe a MD/DO and a PsyD/PhD) and some other staff? What role would a psych nurse play in a pvt practice? Are they actually necessary? How are most practices setup?

Any info would be appreciated. I'm really interested in the business aspect of medicine and am looking to see which of my specialty interests match well with entrepreneurship.

 

[vmc303]

This all sounds very bizarre to me. There's actually a requirement that you must have undergone analysis for several years before entering training? What would be your reason for entering therapy in the first place? Just for kicks? This is getting more and more away from the model of psychiatrist as physician and closer to one of a universal "life coach," charging exorbitant fees to fix problems which might not exist (and for most people, probably don't). No wonder this sort of thing really only flies in Manhattan and Beverly Hills.

To do post-residency training in psychoanalysis is a serious undertaking. You do this at one of the many Psychoanalytic institutes across the county. There are places that do more classic pschyoanalysis (based on Freud's ideas) and places that do more Jung style analysis.

The first, almost universal requirement is to be in anaylsis yourself for at least a couple of years with one analyst, BEFORE entering such a program and then certainly for the length of the training program. Anaylsis is such a personal, intimate encounter - only someone who has thoroughly analyzed themselves could hope to engage other people in the process. Bear in mind that just being in analysis yourself is a very expensive undertaking and a very serious commitment.

They also require that you have been licensed and seeing patients in some capacity for several years. If you've done a resisdency in psych, this usually fufills this. But note, the VAST majority of psychoanalysts are NOT physicians. Probably b/c you simply don't need to be.

Also note, there's some confusion about terms. Psychotherapy and Psychoanalysis are two very distinct things. Any mental health professional could be called a psychotherapist. Psychoanalysis is a very specific, very involved type of psychotherapy.

For more try these links to two major institutes training info pages:

SF Jung Institute

NY Psychoanalysis

They both give info on their training programs in detail.

 

[john182]

This all sounds very bizarre to me. There's actually a requirement that you must have undergone analysis for several years before entering training? What would be your reason for entering therapy in the first place? Just for kicks? This is getting more and more away from the model of psychiatrist as physician and closer to one of a universal "life coach," charging exorbitant fees to fix problems which might not exist (and for most people, probably don't). No wonder this sort of thing really only flies in Manhattan and Beverly Hills.

You've hit the point dead on: psychoanalysis is for people with too much time and money. It's not "real" illness treatment IMHO.

There is a difference between the acute psychotic and the just-broke-up-with-boyfriend. One is an illness, the other isn't. In reality, modern research would say that exploring childhood reveals a lot of things but not necessarily anything that could help anyone at all.

The reason for you to undergoe psychoanalsysis yourself before being a certified psychoanalyst is to basically learn to appreciate your own opinions of yourself trasnference, counter-transference, etc., .

It hasn't exactly been revolutionary or progressive in finding aetiologies or treatments and has had 50-100 years to do so (like psychotherapy in general!! Ooh controversial!!).

If you ar ein psychiatry training, you're better off reading Dale Carnegie.

 

[OldPsychDoc]

This all sounds very bizarre to me. There's actually a requirement that you must have undergone analysis for several years before entering training? What would be your reason for entering therapy in the first place? Just for kicks? This is getting more and more away from the model of psychiatrist as physician and closer to one of a universal "life coach," charging exorbitant fees to fix problems which might not exist (and for most people, probably don't). No wonder this sort of thing really only flies in Manhattan and Beverly Hills.

Which is exactly why many of us blame psychoanalysis for the marginalization of psychiatry with respect to medicine.

Of course, I may just be saying this because my mother didn't breast-feed me long enough...