What goes into landing a private practice job?

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goghz4life

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Hi everyone,

I am a resident at a university program who recently started thinking about going into private practice after residency. I haven't had much exposure to private practice through my program and I was wondering what are some things I can do during residency that will help me land a good gig in a desirable location. I know for academia good LORs, research and residency evaluations are important but I suspect it's quite different for private practice. Do practices care about your evaluations or a letter from your program director? Is it more important to network with community psychiatrists?

Thanks so much!!

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Many (?most i think the last count is like 55%?) of the psychiatry private practices are one man/woman shows that don’t take insurance. Even if you take insurance there’s no big advantage in joining a group. The exact ins and outs depend on the geography a lot. Most groups especially the insurance taking ones have patients flowing out of their ears. You should just call them and see if they’d take you—I guess that’s basically “networking”?

If I were to build a practice today and in charge of recruiting a new associate, the biggest thing I’d be looking for would be some experience or willingness to deal with the business aspect. So the most valuable asset is actually having had run their own practice that’s profitable. So I think even if you don’t want to do a full time solo practice it’s useful to explore how you might make that work. Also, I would say if you join a group practice if there’s no clear path towards equity ownership it’s a nonstarter.
 
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Many (?most i think the last count is like 55%?) of the psychiatry private practices are one man/woman shows that don’t take insurance. Even if you take insurance there’s no big advantage in joining a group. The exact ins and outs depend on the geography a lot. Most groups especially the insurance taking ones have patients flowing out of their ears. You should just call them and see if they’d take you—I guess that’s basically “networking”?

If I were to build a practice today and in charge of recruiting a new associate, the biggest thing I’d be looking for would be some experience or willingness to deal with the business aspect. So the most valuable asset is actually having had run their own practice that’s profitable. So I think even if you don’t want to do a full time solo practice it’s useful to explore how you might make that work. Also, I would say if you join a group practice if there’s no clear path towards equity ownership it’s a nonstarter.

Why is an associate with business experience important for you? You’re just hiring him as an employee while you run the business aspect so why does he need to be well versed?
 
Why is an associate with business experience important for you? You’re just hiring him as an employee while you run the business aspect so why does he need to be well versed?

I would only hire an associate with an eye on eventual promotion into a partner. I'm not the type of business owner who brings a rotating roster of new graduates (often women), promise some unrealistic starting salary, burn and churn and profiteer off of that cycle. In an idea world, I would bring on an associate, mentor him or her to grow the business, and have a compensation model that's directly tied to performance and ownership. In theory this can be done for NPs/PhDs etc. as well but as of right now the market is less favorable so this is not as necessary.

Also, unlike in other practices that are driven by a lot of admin/business development work (in particular negotiation with large payers), in psychiatry the real value of a managing partner, ESPECIALLY if you take insurance, is fairly minimal, mainly having to deal with real estate and HR, both of which can also be outsourced for a price. It's a bit unconscionable in my mind to extract 30-40% overhead from an associate billing and provide next to nothing. Academia and large systems do this all the time and this is very much a recipe for someone to drop out of your group and start their own shop--which is exactly what happens (see above 50% solo rate).
 
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It's hard to say there's a way to do it when there's a shortage of psychiatrists in many areas, so in many areas there's not an established norm.

What the practice wants may vary per the practice. Some may just want to get a doctor that'll churn out patients lightening speed and rake in cash, others might care about the real quality of the psychiatrist, others might just want another warm body that's not going to be an a$$hole at work so they can fill in that empty office and turn it into a mechanism that's going to churn in cash.
 
Or get a side job to pay the bills and open your own until you build a patient base.
 
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