Thinking of transitioning to private practice form a large telehealth company

[petibon25]

I'm a couple of years out of residency and looking for perspectives on a career pivot.

I'm currently working for a pretty large telehealth company that I'm sure most have seen in various social media streams. I adore most of my patients and find a sense of fulfillment from our interactions, but I'm feeling utterly burnt out. I've tried to brainstorm why this is the case, and here are a few contributing factors: 1) lack of autonomy with the patient population that I "accept" into my patient panel, 2) the oversight into my "performance" metrics (eg the inclusion of two codes being more advantageous than one but really there are just some instances when one code IS the appropriate thing to do! and 3) I am really confused as to how exactly I am getting paid based on patient interactions, and the lack of transparency here really bothers me.

Transitioning to private practice has crossed my mind as a possible outcome as I feel that it would lend to more autonomy over what my life looks like and how I provide care. I've talked with others in the field who have also suggested that operating in the world of PP would also lend to a higher hourly pay, which would translate to working less.

Is this true? I'm located in an area where I've been told that 99214 translate to ~$140-160/encounter, and we even have one insurance (that I'm in the last stages with credentialing) that will pay psychiatrists $200/hour even in the absence of medication management. But I worry that the essence of 'burn out' will not be remedied by this switch and that it is actually just the landscape of outpatient psychiatry that is draining.

Has anyone been in a similar situation and made the switch?

Really just looking for other people's experiences with working "soul challenging" outpatient corporate gigs and what it looked like for them - fulfillment wise - after transitioning to their own private practice.

thank you!

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[Atreides]

Are you sure about those rates? That’s on the higher end for solo private practice reimbursements. Assuming 90833s are proportional, that’ll come out to around $500/hour for two 30 minute encounters. Certainly not unheard of but even in California, you’re not getting those rates unless you’ve negotiated up from the initial offer.

 

[petibon25]

I'm 100% positive! I've asked other psychiatrists in my area and have heard the same things from both. I should preface this by saying that I live in a state where we have insurance companies that do not exist elsewhere. So the main insurance companies that we utilize are likely not utilized by other psychiatrists in the US.

 

[TexasPhysician]

What state are we talking about? It isn’t Texas. Are you pleased with where you live? Is a bigger change something to consider?

There are many causes of burnout. Spending some time identifying the cause would greatly assist with determining whether this change is worthwhile.

Most of the time I love my private practice. I can choose my hours, who to terminate care with, where I work, and who is working around me. There are days when I don’t enjoy the admin aspects, firing staff, and the difficulty taking longer vacations. Sometimes I ponder doing telepsych only, buying a RV, homeschooling my kids, and traveling around the US. Maybe 1 day.

Our careers have so many options. At times, I think it is normal to wonder whether better options exist. I purposefully don’t maintain just 1 job because I enjoy the diversity, and you never know what you may enjoy more until you try it. I also think it is very important to maximize our non-career life. It is really hard to not burnout when there isn’t a strong non-work life that excites us.

Can expenses be cut? With my current set-up, I can afford to make a large stupid purchase periodically. I’m planning to get a new to me car this year, but I don’t really need one. I just want one. At some point, I plan to reduce working hours more than I already have. I wonder if I’d be happier significantly cutting hours and having a strict budget.

I’ve spoken to some psychiatrists in the USA that are unhappy with the USA and strongly considering a move to Canada. I then spoke with some Canadian psychiatrists who ended up being unhappy with Canada and strongly considering a move to another continent. We are all in various stages of the pursuit of happiness. Burn-out is real, but there are so many factors that impact our joy. A big career change may certainly be the fix, but I’d reflect on much of life to help determine whether other changes may improve it more.

 

[J ROD]

I would suggest a middle ground. Looking into options where an employer will give you more autonomy and greater say in what you will do.

It took me some years but I have found that for the most part with my current employer. I have enough say in what I do and who I see for the pay and stability of not having to run my own business and get patients in the door.

 

[petibon25]

What state are we talking about? It isn’t Texas. Are you pleased with where you live? Is a bigger change something to consider?

There are many causes of burnout. Spending some time identifying the cause would greatly assist with determining whether this change is worthwhile.

Most of the time I love my private practice. I can choose my hours, who to terminate care with, where I work, and who is working around me. There are days when I don’t enjoy the admin aspects, firing staff, and the difficulty taking longer vacations. Sometimes I ponder doing telepsych only, buying a RV, homeschooling my kids, and traveling around the US. Maybe 1 day.

Our careers have so many options. At times, I think it is normal to wonder whether better options exist. I purposefully don’t maintain just 1 job because I enjoy the diversity, and you never know what you may enjoy more until you try it. I also think it is very important to maximize our non-career life. It is really hard to not burnout when there isn’t a strong non-work life that excites us.

Can expenses be cut? With my current set-up, I can afford to make a large stupid purchase periodically. I’m planning to get a new to me car this year, but I don’t really need one. I just want one. At some point, I plan to reduce working hours more than I already have. I wonder if I’d be happier significantly cutting hours and having a strict budget.

I’ve spoken to some psychiatrists in the USA that are unhappy with the USA and strongly considering a move to Canada. I then spoke with some Canadian psychiatrists who ended up being unhappy with Canada and strongly considering a move to another continent. We are all in various stages of the pursuit of happiness. Burn-out is real, but there are so many factors that impact our joy. A big career change may certainly be the fix, but I’d reflect on much of life to help determine whether other changes may improve it more.

I really appreciate your response and perspective! I am pleased with where I live as most of my family network and friends live here. I think that a bigger change that is at play relates to a recent life transition that I've undergone. This has significantly impacted how I relate to my work in terms of its priority.

The level of autonomy with private practice I think is what feels high on my list. Autonomy has always been very high on my core list of values. I'm currently doing telepsych only, and in many ways I love the convenience of working from home. But then at the end of my days sometimes I'll step outside and feel like I've been so disconnected from the world all day! A hybrid set up seems ideal for me, and I think that is what I'd be able to achieve in PP. Unfortunately there really isn't much of a job market in my area aside from joining a few other clinics and a couple of other very dysfunctional hospital systems so in that way the landscape is actually quite limited.

Thank you for normalizing my wonder about other options/better options and for giving me that food for though to consider maximizing my non-career life. That is an area that could be explored for me.

As for expenses: they can be cut significantly within the next two months. I'm at the tail end of my student loans (i'm SO close!) but until that is paid off, I have a significant amount that is accounted for every month. Other than that, my family and I live quite simply.

Again thank you for your time and your thoughtful response. I really do appreciate it

 

[petibon25]

I would suggest a middle ground. Looking into options where an employer will give you more autonomy and greater say in what you will do.

It took me some years but I have found that for the most part with my current employer. I have enough say in what I do and who I see for the pay and stability of not having to run my own business and get patients in the door.

Thank you! I did ask for more autonomy over my intakes, and this is the set up that has lended to where I am right now. There are some other things that perhaps I could ask for and I think I will explore that in the next conversation that I have with them.

 

[splik]

Given there are few jobs worse than these large telehealth companies, I think you will be happier whatever move you make. Private practice is not for everyone but it does offer unparalleled autonomy which for many of us beats out money. I’m in my third yr of pp and on track to exceed my compensation while employed at this point (my employed comp including benefits was around 450k). I also work far less than I used to.

I will say this is a riskier time to be transitioning into pp and people are losing their jobs (and this insurance) and cutting back on expenses etc. many people are finding it harder to recruit and retain pts. That is not to mention competing with larger companies. These tech enabled PE back companies and the proliferation of NPs in some areas.

However if it turns out outpatient isn’t for you, you might prefer inpatient, residential, IOP/PHP, corrections, utilization management etc lots of different options and they are not mutually exclusive. Outpatient isn’t all the same either. Personally i can’t think of anything worse than general adult outpatient psych but there are many different types of outpatient practice beyond that

 

[hamstergang]

I spent years doing general outpatient C&A psych for a large hospital system. While I generally loved it, I was working too much. I then went to a small group PP to do similar work. While this fixed many of the issues that came along with a large system, I still ended up working too much.

I see many people doing well with outpatient work in different settings (I think nearly everyone who does PP loves it), but I came to find out that I just couldn't do outpatient in a way that worked for me. So, you may find that the change in setting does it for you, but you may also find that outpatient just isn't best for you. I'm now in a residential program and love it. Like splik says above, there are other types of work as well that may click better for you.

 

[Stagg737]

I spent years doing general outpatient C&A psych for a large hospital system. While I generally loved it, I was working too much. I then went to a small group PP to do similar work. While this fixed many of the issues that came along with a large system, I still ended up working too much.

I see many people doing well with outpatient work in different settings (I think nearly everyone who does PP loves it), but I came to find out that I just couldn't do outpatient in a way that worked for me. So, you may find that the change in setting does it for you, but you may also find that outpatient just isn't best for you. I'm now in a residential program and love it. Like splik says above, there are other types of work as well that may click better for you.

Small counterpoint to the bolded, this is largely dependent on either having full or near full autonomy over how you practice OR having your own PP and not minding the admin side. I know a couple of docs who worked for local private practices who left because they got tired of 15 minute follow-ups for patients seeking benzos and stimulants (one of these places is a notorious pill mill around here) and pressure from the owners to grind more patients. I have a couple of colleagues at our academic center who took this route and another 1 or 2 I know that left PP to work outpatient at the VA.

I do agree that most outpatient docs in PP that I know do enjoy it, but the grass isn't always greener.