What to consider when thinking about going to PP?

[DynamicDidactic]

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Hey all,

If I am considering switching out of academia into a private practice, what should I consider? Potentially looking to join a PP that is salaried with typical benefits. What should I be aware of, both changes professionally and to personal life, when considering the option.

TIA

 

[WisNeuro]

Hey all,

If I am considering switching out of academia into a private practice, what should I consider? Potentially looking to join a PP that is salaried with typical benefits. What should I be aware of, both changes professionally and to personal life, when considering the option.

TIA

Really depends on the particulars of the setup. PP life is wildly variable.

 

[Doctor Eliza]

In true psychologist fashion, I'm going to answer a question with more questions. 🙂

What do you like about academia? What are you trying to get away from and hoping that you can find in PP?

Do you focus on a specific population which might influence how you practice? For example, I see kids and it is really hard to get away from having at least some evening hours.

I love private practice, but much of what I love is being my own boss...seems you would be working for someone.

Happy to dialogue some, as I have done PP for 15 yrs, first working for someone as a contractor then as a solo practice owner.

 

[Sanman]

This really depends on your expectations. Salaries (aka w-2) in private practice can be alright. However, benefits may not be so great. If salary is important, VA or AMC might be worth looking into for comparison. If flexibility is key, private practice is easiest.

 

[AcronymAllergy]

Agreed that PP is a bit like the wild west and highly variable, especially compare to the VA and AMC salaried positions.

The major things I'd look at: the salary itself, workload expectations, PTO, and retirement. Then smaller things like CE/licensing/board certification/other supports. If it's a salaried position, I'd want to be sure they were going to be supplying patients, administrative supports, any materials you need, etc. And I'd want to know that I'd be getting paid for no-shows, since as a salaried provider, you're probably not working with any sort of profit sharing or productivity bonus system (although if it's there, that could be a big plus vs. VA and some AMCs). They probably should also provide malpractice if you're salaried.

Since you're coming from academia, if you have interest, you could also see if they have any research involvement.

 

[PsyDr]

Hey all,

If I am considering switching out of academia into a private practice, what should I consider? Potentially looking to join a PP that is salaried with typical benefits. What should I be aware of, both changes professionally and to personal life, when considering the option.

TIA

1) The split, or the salary.... Options for making more for additional work. This is the primary importance, because it will guide the rest.
2) The volume of patients. Do they have enough patients to support you, long term? Are they expecting a manageable case load, which they are providing to you? Do they expect you to find patients? Are they willing to put your caseload in the contract?
3) Payor mix. Are they going to give you a mix of private pay, private insurance, and medicare? Or are they trying to send you all of their medicare patients, and taking the choice stuff for themselves? This still matters if you are salaried
4) Is there partnership opportunity? This is standard in medical practices, but not in psychology practices. It may be useful to cite the former for justification. If you can become a partner, you can take a lower salary, and then get paid a quarterly dividend (as a co-owner) which is taxed at ~15%
5) Admin assistance (e.g., psychometrician, after hours service, records keeping, etc).
6) Health insurance + 401k. This may sound silly, but some types of corporate structures will require the owner to offer you the same as they get (e.g., I have to offer all of my employees the same 401k as I get, in order for the bank to offer it to me; there are health insurance discounts for "groups" ).
7) The physical office- it's where you will spend the majority of your day. It's important that you like the appearance of your office. Can you decorate?
8) coverage for vacation/holidays, especially if you are in a state where you can admit patients to the hospital
9) Hours they are open- there could be some expectation for being there 5-6pm due to working professional patients. If so, are there options to come in later on some days?

 

[smalltownpsych]

Hey all,

If I am considering switching out of academia into a private practice, what should I consider? Potentially looking to join a PP that is salaried with typical benefits. What should I be aware of, both changes professionally and to personal life, when considering the option.

TIA

Salaried position is kind of interesting for a private practice. All of the above questions are great. I would emphasize having opportunity to get productivity based compensation. Might make sense to start with a salary while you are getting things going, but have options down the road for other types of arrangements. For me one benefit of private practice is that if I work hard and efficiently, I get rewarded. Another benefit is flexibility of patients, hours, type of work etc. another way to think about it is that it might be great experience to learn what you want to do in a couple of years when you start your own practice. 😊

 

[PsyDr]

10) How CE time is factored in. Is it vacation? Is ot sick time? Is it something else?
11) If you have student loans: can you move some of your money into student loan reimbursement in line with the new 2022 employer 401k match? This could be tax advantaged for both of you.

IRS issues important interim guidance on employer matching contributions made to retirement plans related to employee student loan payments | Internal Revenue Service

IR-2024-217, Aug. 19, 2024 — The Internal Revenue Service today issued interim guidance for sponsors of 401(k) and similar retirement plans that provide, or wish to provide, matching contributions based on eligible student loan payments made by their participating employees.

www.irs.gov

 

[Sanman]

Salaried position is kind of interesting for a private practice. All of the above questions are great. I would emphasize having opportunity to get productivity based compensation. Might make sense to start with a salary while you are getting things going, but have options down the road for other types of arrangements. For me one benefit of private practice is that if I work hard and efficiently, I get rewarded. Another benefit is flexibility of patients, hours, type of work etc. another way to think about it is that it might be great experience to learn what you want to do in a couple of years when you start your own practice. 😊

This is something that people need to think about in light of our reimbursement structure. There are many types of work that are simply not worth doing due to the lack of efficiency. Make sure you are not getting stuck with those cases.

 

[DynamicDidactic]

Thanks for all the replies so far.

To address some points and clear up some questions, in broad strokes:

I make good money, could make more (benefits here are as good as most employers)
I would lose the flexibility of academia but I am getting tired of all the extra, out-of-office work that I'd rather free up my headspace and stress for family. It would be nice not to have to always feel that I can be doing more (e.g., writing, planning, prepping courses) and instead finish the day and start anew the next day.
I do DBT and I would get a chance to really do it all the time but I wouldn't be doing all DBT.
The students are getting to me, a bit.

Questions
Am I fooling myself on the work hours and stress?
Does PP seem better only b/c I am feeling stressed now?
I could eventually start my own practice but that is not a step I am looking to take now.

 

[Sanman]

Thanks for all the replies so far.

To address some points and clear up some questions, in broad strokes:

I make good money, could make more (benefits here are as good as most employers)
I would lose the flexibility of academia but I am getting tired of all the extra, out-of-office work that I'd rather free up my headspace and stress for family. It would be nice not to have to always feel that I can be doing more (e.g., writing, planning, prepping courses) and instead finish the day and start anew the next day.
I do DBT and I would get a chance to really do it all the time but I wouldn't be doing all DBT.
The students are getting to me, a bit.

Questions
Am I fooling myself on the work hours and stress?
Does PP seem better only b/c I am feeling stressed now?
I could eventually start my own practice but that is not a step I am looking to take now.

What are your salary expectations? $100-125k easily doable. $150k+ will take more searching as an employee.

If you want to do DBT, are you planning on treating borderlines or severe bipolar?

Boundaries are also boundaries. Patients are happy to push you for more unpaid work (letters, phone calls, book recs, insurance paperwork for heache insurance, etc.)

 

[MCParent]

Thanks for all the replies so far.

To address some points and clear up some questions, in broad strokes:

I make good money, could make more (benefits here are as good as most employers)
I would lose the flexibility of academia but I am getting tired of all the extra, out-of-office work that I'd rather free up my headspace and stress for family. It would be nice not to have to always feel that I can be doing more (e.g., writing, planning, prepping courses) and instead finish the day and start anew the next day.
I do DBT and I would get a chance to really do it all the time but I wouldn't be doing all DBT.
The students are getting to me, a bit.

Questions
Am I fooling myself on the work hours and stress?
Does PP seem better only b/c I am feeling stressed now?
I could eventually start my own practice but that is not a step I am looking to take now.

Not that this needs to be answered on the forum, but a thing not often discussed in pp planning is spousal employment. PP challenges look a lot different married to a teacher vs married to a physician.

There were a lot of days toward the end of my time in academia when I looked at what I pulled in vs hours put in in my tiny practice against the pretty substantial workload I had in academia. But then I was also doing lgbtq+ focused research and teaching diversity topics in Texas.

 

[summerbabe]

I would lose the flexibility of academia but I am getting tired of all the extra, out-of-office work that I'd rather free up my headspace and stress for family. It would be nice not to have to always feel that I can be doing more (e.g., writing, planning, prepping courses) and instead finish the day and start anew the next day.

Are you open to working a typical 40/wk job in an agency setting (local hospital system, VA, etc) where you clock in and clock out and hopefully finish all your work during your shift and aren’t expected to answer emails/phone calls outside of work?

Some of your other considerations (salary vs fee for service split, good benefits) also seem more likely in an agency setting.

But you lose a ton of flexibility and control in exchange for things like being paid whether a patient shows up or not and having lots of admin/logistics taken care of for you.