Variable earnings in private practice

[erg923]

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We have had many discussions in the recent past about earning potentials. Just wanted to share something.

I continuously here anecdotal stories from supervisors and advanced students about people they know who make an absolute killing in private practice. Although this is good, the ones I have heard over and over are of people who are making over 200k who basically just fell into the situation out of luck or coincidental contacts. The ones lately have all been people who got into a relativity large group practices in mid size cities. These people were making over 200k in just a few years...supposedly anyway. From my understanding, these were established practices that basically operated like a law firm. Salary until your patient load is established then basically you start splitting the earnings. These places sounded like machines too...and did mostly cash only, although I'm not positive about that. Alot of assessment too, I'm sure.

I find this encouraging, yet frustrating too. I have neither the established contacts nor the startup capital to hang a shingle and feel like the only thing I can do is "stumble" into a great situation like this through dumb luck. I have contacts back in my home state...including PP folks, but most are independent or small groups. Nothing like the above. Where are the practices like the ones above and how do people find them? Cold calling?

 

[roubs]

You don't want to get a small business loan and start aggressively marketing? :/

 

[ClinicalABA]

These people were making over 200k in just a few years...supposedly anyway.

I'm a little skeptical about this figure and what is meant by "private practice". Subtracting two weeks for vacation each year, this would mean that the therapist is paid at an average of $100/hr for 40 hrs each week. The actual reimbursement rate would be more, assuming the need to cover operating expenses (e.g. rent, electricity, phone, clerical and billing staff, etc.). For this to be real, there would have to be some high-fee consultation and/or a large population of extremely wealthy private-pay clients (or 80 hour weeks). If you play your cards right, have specialized skills that set you apart from other less-expensive therapy providing disciplines, and have some luck, it's not unheard that as a doctoral level psychologist you could be making half this amount working in some specialized setting, but that would likely have to involve more funding streams than direct pay for service clients. In my case, this has taken about 10 years post Ph.D., and has involved a willingness to get my hands dirty with a lot on non-clinical stuff (e.g. administration and program development). If these 200k/year private practice gigs actually exist, they are more of a pipe dream than a realistic goal.

 

[Therapist4Chnge]

It can also be geographically limited. I know people who charge $160 & $185/session, but they live in SF and NYC respectively. I still go back to my assertion to make real money in private practice you need people working for you while you do something else. It requires startup costs to cover the office space, but it is nice to get paid for other people's work. If you stick to a solo practitioner model, you are forever beholden to your billable hour.

 

[thepug]

You don't want to get a small business loan and start aggressively marketing? :/

Indeed.

I think this is why it is so damn important to get your degree in a place you plan on staying. I have a lot of friends who went to a good uni out in the sticks and now are asking where their 100k+ job is. Hello, East Coast. People memorized the USnews WR lists, but didn't care to take a look at salary info by location.

I feel folks that have a natural business since (also found among prison escape artists😉) are the ones who succeed here.

 

[erg923]

Indeed.

I think this is why it is so damn important to get your degree in a place you plan on staying. I have a lot of friends who went to a good uni out in the sticks and now are asking where their 100k+ job is. Hello, East Coast. People memorized the USnews WR lists, but didn't care to take a look at salary info by location.

I feel folks that have a natural business since (also found among prison escape artists😉) are the ones who succeed here.

Finish internship year. Study for EPPP. Organize an escape from Alcatraz. Earn bucks in a lucrative practice. Got it.

 

[stigmata]

The reality is nobody will tell you the secrets as you are competition. There is easy and good money to be made everywhere, but until you know how to find it and keep it things can be slim. Psychotherapy is not and will never be profitable for psychologists. Your school won't teach you a thing about making a living because nobody there knows how. Getting your degree in the same place you plan to live is probably not a meaningful variable. Find someone who is successful in the area you want to be and make them your friend. Or you can hire a consultant to help you. I make good money doing this in addition to my psychopharm and assessment work.

 

[erg923]

The reality is nobody will tell you the secrets as you are competition. There is easy and good money to be made everywhere, but until you know how to find it and keep it things can be slim. Psychotherapy is not and will never be profitable for psychologists. Your school won't teach you a thing about making a living because nobody there knows how. Getting your degree in the same place you plan to live is probably not a meaningful variable. Find someone who is successful in the area you want to be and make them your friend. Or you can hire a consultant to help you. I make good money doing this in addition to my psychopharm and assessment work.

Can we "friend" people on SDN?😉

 

[ClinicalABA]

The reality is nobody will tell you the secrets as you are competition.

This may be a tad cynical, but there is some truth to it. At the very least, nobody is going to tell you the secret unless: (a) you ask; and (b) there is some advantage to them in telling you (or at least no disadvantage).

There is easy and good money to be made everywhere, but until you know how to find it and keep it things can be slim.

Quite true. I'd also add that there is also some "hard" money to be made if the situation dictates it.

Psychotherapy is not and will never be profitable for psychologists. Your school won't teach you a thing about making a living because nobody there knows how.

Yeah- if your only advice on how to acquire and maintain profitable employment in an applied setting is coming from people who work primarily in an academic setting, good luck to ya! If you don't have good business skills like marketing (not sleazy "take advantage of the consumer" marketing, but "letting people who need your service know you exist and that you can help them" marketing) and administrative skills (do you know how to manage staff? Hire good employeess? Fire bad ones?), as well as good clinical , you are significantly limited your career and salary options. You should try to begin devveloping these skills on internship- Talk to your supervisors about their administrative responsibilities. If you're in a setting that bills clients or insurance companies directly, get to know the billing manager. Ask about the funding streams. Even ask for opportunities to observe or get involved in the non-clinical aspects of the program- worse they can do is say "no". In summary, if the only professional advice and guidance you've received over the last 4+ years of your life has come from academic psychologists, you've got some work to do.

 

[aequitasveritas]

I don't know that psychotherapy is not profitable for psychologists.

Example:
70 (my eye ball for average insurance pay IME in practice) x 35 (good load of patients:sometimes 40, sometimes 30 in any given week) x 50 (let's say we take 2 weeks off a year) = 122,500.

Not a great salary, but a good, livable one.

If we took all tricare patients we'd get 77/session. Then we're up to 134,740.

These are modest projections

 

[thepug]

I don't know that psychotherapy is not profitable for psychologists.

Example:
70 (my eye ball for average insurance pay IME in practice) x 35 (good load of patients:sometimes 40, sometimes 30 in any given week) x 50 (let's say we take 2 weeks off a year) = 122,500.

Not a great salary, but a good, livable one.

If we took all tricare patients we'd get 77/session. Then we're up to 134,740.

These are modest projections

Well 122k - overhead - insurance - slow weeks - tax = app. 105k

What is a great salary? Like 200k? Who the F makes 200k? I think 140k should make anyone completely ecstatic. Especially if your spouse works.

 

[Markro311]

Well 122k - overhead - insurance - slow weeks - tax = app. 105k

What is a great salary? Like 200k? Who the F makes 200k? I think 140k should make anyone completely ecstatic. Especially if your spouse works.

I'd imagine that overhead, insurance, slow weeks, and taxes would shave off significantly more than just 17k in that scenario. Or are you assuming that you are not the owner of a practice? Rent, utilities, possibly paying staff or a billing service, marketing costs, insurance, will add up VERY fast.

 

[Therapist4Chnge]

Grossing $120k is really not feasible once you factor in business costs: taxes, rent/lease, utilities, malpractice insurance, etc. You can write off/depreciate stuff like furniture, but $70 per patient is only doable in high volume.

 

[stigmata]

I bring in well over double to actually make 6 figures, so 120k is really just a govt job after taxes, rent etc...

 

[carolinablue]

Do people get payed during internships?
how much does one make right out of their program with a Psy-D??

 

[erg923]

Do people get payed during internships?
how much does one make right out of their program with a Psy-D??

Internships are payed...poorly. Most are in the low to mid 20s.

Second questions is very hard to answer because it depends on alot of factors. In the clinical world (i.e.,. not academics or research), generally speaking, the degree means little if you aren't licensed yet..and most states (38/50 I think) still require one year of supervised post-doctoral practice experience before being eligible for an independent license. Formal "post-doc" positions range from the low to mid 30s (hospitals, academic med center, CMHCs) to the mid 40s at VA med centers. Positions that are not formal post-docs but that do offer supervisions that can be counted for licensure range from the 40s to the 50s. Some can also obtain the required supervision by working for or within a private practice. These can range from unpaid to quite lucrative.

 

[medium rare]

Grossing $120k is really not feasible once you factor in business costs: taxes, rent/lease, utilities, malpractice insurance, etc. You can write off/depreciate stuff like furniture, but $70 per patient is only doable in high volume.

No, it's not. $70/session (90806) is actually on the low side for insurance reimbursement for a licensed psychologist. In my city, United is the largest insurer and they have paid $70 for a 90806 for years. They are on the low side, but they have high volume. It doesn't matter if you see 1 patient or 60, they pay the same.

You can get on United's panel and fill your practice pretty easily with no marketing or advertising. I personally know several psychologists who have done this and they have full practices with very little overhead. If you get on other panels, they tend to pay more ($75 - 90 per session) and you will have more business than you can handle - as long as you're willing to deal with insurance companies. Not a great arrangement, but very doable.

 

[PsychBA]

I bring in well over double to actually make 6 figures, so 120k is really just a govt job after taxes, rent etc...

Woah, woah, hold up, time out, back up the friggin moolah truck, are you saying you make, say 220k/yr just to take home 100k after taxes? Well, I've got to see this to believe it!

 

[Markro311]

Woah, woah, hold up, time out, back up the friggin moolah truck, are you saying you make, say 220k/yr just to take home 100k after taxes? Well, I've got to see this to believe it!

Not just after taxes. After overheard (which varies, and for some can be up to 40-50% of salary - including rent, utilities, paying staff and/or billing service, marketing, etc.), insurance, taxes, etc. Believe it or not, you actually have to pay for many things when you have your own business. 😉

 

[thepug]

Stigmata

Your full of **** on both counts. I doubt you make 220k a year (consistently) and I doubt you pay 120k in overhead. Where do you practice, out of a mansion? Do you have like 5 secretaries? Does your Kleenex box have $100 bills instead of tissues in it? Who does your marketing? A fighter jet that flies over the town a few times a year.

I must have misunderstood because that is the biggest load of BS.

 

[thepug]

No, it's not. $70/session (90806) is actually on the low side for insurance reimbursement for a licensed psychologist. In my city, United is the largest insurer and they have paid $70 for a 90806 for years. They are on the low side, but they have high volume. It doesn't matter if you see 1 patient or 60, they pay the same.

You can get on United's panel and fill your practice pretty easily with no marketing or advertising. I personally know several psychologists who have done this and they have full practices with very little overhead. If you get on other panels, they tend to pay more ($75 - 90 per session) and you will have more business than you can handle - as long as you're willing to deal with insurance companies. Not a great arrangement, but very doable.

How do you get on said panel?

 

[erg923]

Stigmata

Your full of **** on both counts. I doubt you make 220k a year (consistently) and I doubt you pay 120k in overhead. Where do you practice, out of a mansion? Do you have like 5 secretaries? Does your Kleenex box have $100 bills instead of tissues in it? Who does your marketing? A fighter jet that flies over the town a few times a year.

I must have misunderstood because that is the biggest load of BS.

Dude...connections, networking, and informal meetings are how people get jobs in this field...outside the VA at least. You might wanna think about that the next time you're tempted to give the proverbial middle finger to a practicing psycholgist...

 

[edieb]

I don't know that psychotherapy is not profitable for psychologists.

Example:
70 (my eye ball for average insurance pay IME in practice) x 35 (good load of patients:sometimes 40, sometimes 30 in any given week) x 50 (let's say we take 2 weeks off a year) = 122,500.

Not a great salary, but a good, livable one.

If we took all tricare patients we'd get 77/session. Then we're up to 134,740.

These are modest projections

Do you know what a terrible quality of life you would have if you saw 50 patients/week? That would not be sustainable in the long term, espeically if you wanted to have any outside life

 

[stigmata]

No, the practice collects 250k/yr based upon what I bill, and 50% of that is my salary. Plus, I am part owner so I get profits. We employ a FT receptionist, 2 FT psych assistants, a billing company and a lawyer on retainer. We have money to buy stuff when we need it, and I have a company car. We have subcontracted out a few contracts so we make $ on those and don't spend a minute working on them. It is not BS, and no I am not showing you our records.....seriously.

 

[Therapist4Chnge]

No, it's not. $70/session (90806) is actually on the low side for insurance reimbursement for a licensed psychologist. In my city, United is the largest insurer and they have paid $70 for a 90806 for years. They are on the low side, but they have high volume. It doesn't matter if you see 1 patient or 60, they pay the same.

I should have qualified my statement. $70/session can be doable in certain situations like sublets, co-ops, multi-zoned spaces (live/work in the same area), etc. There are definitely office space options for $500-$600/month in the Midwest and/or more rural areas of the country. With taxes, utilities, liability insurance, and similar...it'll be <$1,000/mon in costs.

I'm not advocating that $70/pt is enough for everyone, but some people are wiling/able to go this route. I wouldn't consider this an option, but some people have to work with what is available in their area.

 

[Therapist4Chnge]

No, the practice collects 250k/yr based upon what I bill, and 50% of that is my salary. Plus, I am part owner so I get profits. We employ a FT receptionist, 2 FT psych assistants, a billing company and a lawyer on retainer. We have money to buy stuff when we need it, and I have a company car. We have subcontracted out a few contracts so we make $ on those and don't spend a minute working on them. It is not BS, and no I am not showing you our records.....seriously.

As I've argued before....the above is the best approach for PP folks. Passive and active income streams, ownership v. being an employee, delegating responsibility to maximize your billable time, etc.

 

[IT514]

Stigmata

Your full of **** on both counts. I doubt you make 220k a year (consistently) and I doubt you pay 120k in overhead. Where do you practice, out of a mansion? Do you have like 5 secretaries? Does your Kleenex box have $100 bills instead of tissues in it? Who does your marketing? A fighter jet that flies over the town a few times a year.

I must have misunderstood because that is the biggest load of BS.

Most of the neuropsychologists I have trained under (n= ~10) make at least that much, if not more.

 

[Therapist4Chnge]

Most of the neuropsychologists I have trained under (n= ~10) make at least that much, if not more.

Agreed.

Grossing $200k-$250k in a talk therapy office is not very much once you have more than 1 provider, particularly if you have to pay staff. I'd expect a single neuropsychologist to gross at least that much if they are actually full-time. There are more costs with neuropsych stuff, so you may or may not take come the same % as traditional talk therapy.

 

[aequitasveritas]

Do you know what a terrible quality of life you would have if you saw 50 patients/week? That would not be sustainable in the long term, espeically if you wanted to have any outside life

Dude....50 WEEKS....not 50 patients

 

[medium rare]

How do you get on said panel?

You just apply. It can take awhile to get credentialed (3 months or so) but once you're on, the phone will start ringing. Some panels are closed to new providers but this is less and less the case now, and some panels require a certain number of years licensed before you can apply.

There are people you can hire to do all the paperwork for you and get you on as many panels as you want, makes the process pretty painless. It's really not that hard, just takes some time.

I'm not the best person to answer this because I don't take insurance, but my colleagues who do have filled me in.

 

[thepug]

You just apply. It can take awhile to get credentialed (3 months or so) but once you're on, the phone will start ringing. Some panels are closed to new providers but this is less and less the case now, and some panels require a certain number of years licensed before you can apply.

There are people you can hire to do all the paperwork for you and get you on as many panels as you want, makes the process pretty painless. It's really not that hard, just takes some time.

I'm not the best person to answer this because I don't take insurance, but my colleagues who do have filled me in.

How do you get clients if you don't take insurance?

And how many years of being licensed do some panels generally require?

 

[SmoothJams]

No, the practice collects 250k/yr based upon what I bill, and 50% of that is my salary. Plus, I am part owner so I get profits. We employ a FT receptionist, 2 FT psych assistants, a billing company and a lawyer on retainer. We have money to buy stuff when we need it, and I have a company car. We have subcontracted out a few contracts so we make $ on those and don't spend a minute working on them. It is not BS, and no I am not showing you our records.....seriously.

Can you get together with medium rare and please write a "How to Set Up a Successful Mental Health Practice" book or something? 🙂

 

[Therapist4Chnge]

Can you get together with medium rare and please write a "How to Set Up a Successful Mental Health Practice" book or something? 🙂

There are a number of these out there already, though I admittedly have been tempted to take a stab at a book on related topics.

Zuckerman's "The Paper Office" is probably the most well known. Steve Walfish also put out a good book. There are a few others, which I believe I listed in the Recommended Reading thread at the top of the forum.

 

[medium rare]

How do you get clients if you don't take insurance?

And how many years of being licensed do some panels generally require?

Word of mouth and networking with non-psychologist health providers - PCPs, pediatricians, nurses at outpatient clinics, NPs, attorneys, etc. Many patients will have out-of-network benefits on their insurance, so that will typically pay some of the cost for services.

Most don't require it, but I know of some requiring 2 years and one requiring 5 years. This used to be more of the norm 10 years ago than it is now.

 

[medium rare]

Can you get together with medium rare and please write a "How to Set Up a Successful Mental Health Practice" book or something? 🙂

As mentioned by others, there are several books on this topic. The Successful Therapist by Larina Kase, PsyD, MBA is an excellent resource I would recommend.

 

[Markro311]

Word of mouth and networking with non-psychologist health providers - PCPs, pediatricians, nurses at outpatient clinics, NPs, attorneys, etc. Many patients will have out-of-network benefits on their insurance, so that will typically pay some of the cost for services.

Most don't require it, but I know of some requiring 2 years and one requiring 5 years. This used to be more of the norm 10 years ago than it is now.

Non-psychologist health providers are essential for networking, but so are non-health providers. Libraries, hairstylists, acupuncturists, masseuses, etc. are all great referral networks as well. Giving free talks (at libraries or businesses, etc. - and sometimes you can even get paid), or writing a monthly or even one-time column for a local paper, are also possibilities.

It's also important to do more than just hand out your card to these people. You need to introduce yourself, ask them about their work, explain how your professional interests could help them out. Maybe even take them out to coffee or lunch to discuss all of this. It can and will pay dividends with referrals .

 

[Neuro-Dr]

You can request pay scales from any insurance company and get better data than what you are all speculating. BCBS pays $109 for 90806' $155 for 90847, $212 for 90801 and about $159 for np testing. You would never want to bill less than the allowable amounts as you leave money on the table. My techs are paid by bcbs more than the $70 per hour being thrown around. I have had a couple of years under $200k but not many. If you want to make $100k and can't, you are doing something wrong or are not that good.

 

[Therapist4Chnge]

You can request pay scales from any insurance company and get better data than what you are all speculating. BCBS pays $109 for 90806' $155 for 90847, $212 for 90801 and about $159 for np testing. You would never want to bill less than the allowable amounts as you leave money on the table. My techs are paid by bcbs more than the $70 per hour being thrown around. I have had a couple of years under $200k but not many. If you want to make $100k and can't, you are doing something wrong or are not that good.

What kind of HR caps are you seeing with billing NP testing? Does it differ whether a psych tech or the neuropsychology is doing the testing (for the # of hours allowed, not the $ billed)?

 

[Neuro-Dr]

It completely depends on the group payer. Some plans have no prior auth and those have no caps. Some want a phone clinical for anything over 6 units. some seem to always cap at wither 4 or 6 no matter what. BCBS is the largest % of my patients and about 1/2 total. It pays in the lower half (25-50%) of all plans I participate in. I see kids, so I don't get into to Medicare, but they don't cap much since gero evals don't last too long. I never go over 6 units with kids unless it is TBI and even then it is rare. I dictate reports so never bill multiple hours for report writing, which is usually where you hear NPs complain about rate cuts. Frankly, if you are billing cash only $4k for NP evals you are robbing your patients. But, here in the windy city, it happens all the time. I've seen evals that I could do in 4 hours and families are charge $3-4K. We would bill about $1,300-1,800 for intake, eval and follow up (about 7-8 hours total). The tech hours won't get you more time in the auth, just less money. So, they are worth it only if you could be doing something else at that time. You finished with residency yet T4C?

 

[AcronymAllergy]

It completely depends on the group payer. Some plans have no prior auth and those have no caps. Some want a phone clinical for anything over 6 units. some seem to always cap at wither 4 or 6 no matter what. BCBS is the largest % of my patients and about 1/2 total. It pays in the lower half (25-50%) of all plans I participate in. I see kids, so I don't get into to Medicare, but they don't cap much since gero evals don't last too long. I never go over 6 units with kids unless it is TBI and even then it is rare. I dictate reports so never bill multiple hours for report writing, which is usually where you hear NPs complain about rate cuts. Frankly, if you are billing cash only $4k for NP evals you are robbing your patients. But, here in the windy city, it happens all the time. I've seen evals that I could do in 4 hours and families are charge $3-4K. We would bill about $1,300-1,800 for intake, eval and follow up (about 7-8 hours total). The tech hours won't get you more time in the auth, just less money. So, they are worth it only if you could be doing something else at that time. You finished with residency yet T4C?

I've seen/heard of the $3-4k eval price tag as well, although in general, I think most of the practitioners around here (that I've spoken with anyway, so it's a somewhat small number) aim for $1200-2100. The more expensive sessions seem to be those that run across multiple days and end up with 20-page summary reports. Or they're forensic and include time for travel, records review, etc.

 

[Therapist4Chnge]

It completely depends on the group payer. Some plans have no prior auth and those have no caps. Some want a phone clinical for anything over 6 units. some seem to always cap at wither 4 or 6 no matter what. BCBS is the largest % of my patients and about 1/2 total. It pays in the lower half (25-50%) of all plans I participate in.

Unfortunately, that's what I've see elsewhere. I know most places want to move away from long batteries, but I have concern about such limitations.

I see kids, so I don't get into to Medicare, but they don't cap much since gero evals don't last too long. I never go over 6 units with kids unless it is TBI and even then it is rare. I dictate reports so never bill multiple hours for report writing, which is usually where you hear NPs complain about rate cuts.

How do you keep it at an hour? I can understand the dictation part, but reviewing school records, medical records, imaging, etc?

Frankly, if you are billing cash only $4k for NP evals you are robbing your patients. But, here in the windy city, it happens all the time. I've seen evals that I could do in 4 hours and families are charge $3-4K. We would bill about $1,300-1,800 for intake, eval and follow up (about 7-8 hours total). The tech hours won't get you more time in the auth, just less money. So, they are worth it only if you could be doing something else at that time. You finished with residency yet T4C?

I'd argue that billing $4k for an NP is fair for a more comprehensive evaluation. An 8 hour battery + medical chart/imaging review + consultation with other providers + solid report and followup feedback session.

As for me, I'm in my 2nd year...so I'm starting to poke around for jobs. If you hear of any good neuropsychologist/rehabilitation psychologist positions at major academic medical centers, feel free to pass them along. 😀 The market seems to be in flux, though there are still opportunities at some solid places.

 

[Neuro-Dr]

Well, far be it from me to tell you what you are worth; but your intake code is untimed and paid as if it were 1.5 hours. and with 8 hours of testing, 1 hour of scoring and one hour feedback you'd be at 11.5 hours. Do you charge $350 per hour? What conditions are you seeing that require 8 hours of testing? You can't bill for administration time for paper-and-pencil measures. The only time I get near 8 hours is in a forensic eval. As for records review, that is why the 90801 code is longer and frankly, how long does it really take to review records? We get imaging on lots of folks and once I've seen the dictations, I know what I'm looking at. If there has been tons of testing in the school that merits that much review, why would you need to repeat it all? That should save you testing time. Typically, when I see $4k for an eval, it better have school visits, parent-child interaction observations and a new set of snow tires. These generally do not reflect 16-20 hours of doc time. I bill for what I do and don't make flat fees like that. If you can get, great. But every dollar you take to assess is a dollar that is not available to treat.

 

[erg923]

Well, far be it from me to tell you what you are worth; but your intake code is untimed and paid as if it were 1.5 hours. and with 8 hours of testing, 1 hour of scoring and one hour feedback you'd be at 11.5 hours. Do you charge $350 per hour? What conditions are you seeing that require 8 hours of testing? You can't bill for administration time for paper-and-pencil measures. The only time I get near 8 hours is in a forensic eval. As for records review, that is why the 90801 code is longer and frankly, how long does it really take to review records? We get imaging on lots of folks and once I've seen the dictations, I know what I'm looking at. If there has been tons of testing in the school that merits that much review, why would you need to repeat it all? That should save you testing time. Typically, when I see $4k for an eval, it better have school visits, parent-child interaction observations and a new set of snow tires. These generally do not reflect 16-20 hours of doc time. I bill for what I do and don't make flat fees like that. If you can get, great. But every dollar you take to assess is a dollar that is not available to treat.

The billing process for npsych evals has always been massively confusing to me. There are constantly questions about this on the npsych listserver too.

 

[Therapist4Chnge]

Typically, when I see $4k for an eval, it better have school visits, parent-child interaction observations and a new set of snow tires. These generally do not reflect 16-20 hours of doc time. I bill for what I do and don't make flat fees like that. If you can get, great. But every dollar you take to assess is a dollar that is not available to treat.

Fair enough. I understand the limited resources, but I think we (as a profession) also run into issues by not charging what something is worth. While someone is paying for my time, they are also paying for my expertise. When I was a corp consultant, I ran into this issue all of the time. I'd often get some initial pushback from new business about my fees ($250-$300/hr). Some clients would look elsewhere, and often they'd spend $5k-$10k on someone else, only to come back to me and pay my asking rate. I think NP is the same way.

There are people out there that will charge significantly less than the going rate for an NP eval. I am sure some of those people will provide an adequate assessment and service, but many will not. I think you typically get what you pay for, so going with the cheapest option can often backfire. I know some people flat out can't afford a $3k-$4k eval, so there will always be a market out there for lower cost options, but I think there were be more variance in quality at the lower rates. As one of my mentors once told me, "There is no such thing as a cheap neuropsych eval", as the cost is sometimes in dollars and other times in quality.

*edited to clarify*

 

[erg923]

You can't bill for administration time for paper-and-pencil measures.

Um, what? Can you explain what you meant by this? Maybe I'm misunderstanding something?

 

[Neuro-Dr]

I'm sure there are some NPs who bill $350 per hour in clinical (as opposed to forensic work), I just don't know any. The highest U& C rate I have ever seen was $270 for an untimed intake and so we set our rates there (currently $280). My reaction (not to you T4C) is that I know psychologists who sit down with a glass of wine and write reports for hours and then pass those charges on. I think more often, the longer you do this, the faster and better you get. You are then rewarded by billing fewer hours because you are more efficient. Many of these NPs react by slowing down their report writing and thus padding their bill. I just see more patients. So, I might make less per patient/per eval but see more people. In my view that is the better practice. File this conversation away and see if it resonates down the road when you run your own ship. I will pass along any gigs.

Also, to the other question. You can bill for scoring, interpreting and writing up an MMPI-2, you can't bill for the patient sitting there and completing it.

 

[stigmata]

Of course you can...psych testing by computer. Do it every day.