Why Don't We Teach More About Money and Private Practice In School?

[ThatPsyGuy]

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This thought was just bugging me the entire day. I feel that the business behind private practice/how services are charged is not necessarily touched upon in programs. (Or really, the type of work environments that people psychologists/therapists can work in in general) Particularly earnings that clinicians take home.

For context, I decided to volunteer and do some extra supervised supervision of some of the MA/MS students.

For those who wanted to go into private practice, I sometimes have them perform an exercise where they took their associated CPT Codes for the services they were providing in their practicums/internships and tally up how much they "earned" across different insurance providers, cash pay, splits, etc.

I thought it would be helpful for them to get an idea of the type of money they could potentially bring home and reflect on how that aligned with the lifestyle they wanted. But I never really learned this in my own training, and I had to go and study all of this on my own. When asking some other colleagues they said similar experiences where they either had to find the information themselves or learn a much too late.

Shouldn't this be....normal? Especially considering that about 45% of psychologists (don't know how much for Masters practitioners, but it's a majority im sure) work in private practice? I think that spreading this knowledge earlier is overall advantageous for the entire field. Hell if people knew more about how insurance reimbursement rates, I think we could advocate for favorable outcomes better.

 

[WisNeuro]

While I get that it's important, I wouldn't say that it's an integral part of being a psychologist. Honestly, this info is publicly available in most cases and not all that hard to learn if you just put some time and effort into it. Also, if you teach it in school, by the time they do internship, postdoc, and likely a few years in a system job, they've likely forgotten a good deal of the info. I'm fine with this not being a required part of training in grad school, personally.

 

[MCParent]

This thought was just bugging me the entire day. I feel that the business behind private practice/how services are charged is not necessarily touched upon in programs. (Or really, the type of work environments that people psychologists/therapists can work in in general) Particularly earnings that clinicians take home.

For context, I decided to volunteer and do some extra supervised supervision of some of the MA/MS students.

For those who wanted to go into private practice, I sometimes have them perform an exercise where they took their associated CPT Codes for the services they were providing in their practicums/internships and tally up how much they "earned" across different insurance providers, cash pay, splits, etc.

I thought it would be helpful for them to get an idea of the type of money they could potentially bring home and reflect on how that aligned with the lifestyle they wanted. But I never really learned this in my own training, and I had to go and study all of this on my own. When asking some other colleagues they said similar experiences where they either had to find the information themselves or learn a much too late.

Shouldn't this be....normal? Especially considering that about 45% of psychologists (don't know how much for Masters practitioners, but it's a majority im sure) work in private practice? I think that spreading this knowledge earlier is overall advantageous for the entire field. Hell if people knew more about how insurance reimbursement rates, I think we could advocate for favorable outcomes better.

Someone should write a paper!

APA PsycNet

psycnet.apa.org

 

[Sanman]

While I get that it's important, I wouldn't say that it's an integral part of being a psychologist. Honestly, this info is publicly available in most cases and not all that hard to learn if you just put some time and effort into it. Also, if you teach it in school, by the time they do internship, postdoc, and likely a few years in a system job, they've likely forgotten a good deal of the info. I'm fine with this not being a required part of training in grad school, personally.

The other half of this is that the business is frequently changing. CPT codes change on an annual basis. What you learn as a student might be outdated by the time you can use the information. That said, I am a fan of students learning the basics. Too many folks that don't know time limits of a 90834 vs 90837.

 

[quickpsych]

I don't necessarily think it needs to be required, as others said it's pretty readily available information. That said my program, at least at the time, dedicated a portion of one course to private practice building/management and understanding associated costs, liabilities, pros/cons, getting office space, testing considerations, inventory management, marketing, etc, etc. In fact one of the projects was to assign groups and build complete business plans for a private practice. In reflecting on this, the school was located in an area that had a lot of high to very high income households, private boarding schools for middle school/high school, and thus tended to have a lot of small boutique practices in the surrounding area that catered to these populations.

So probably my experience was an exception not the norm in graduate programs.

 

[oliversacks4thewin]

Just wanted to add that if we require teaching it, it's now fair game for testing on it too.

Do you think it's advantageous to include questions on the EPPP related to business/practice management?

 

[ThatPsyGuy]

Just wanted to add that if we require teaching it, it's now fair game for testing on it too.

Do you think it's advantageous to include questions on the EPPP related to business/practice management?

No. -

While I get that it's important, I wouldn't say that it's an integral part of being a psychologist. Honestly, this info is publicly available in most cases and not all that hard to learn if you just put some time and effort into it. Also, if you teach it in school, by the time they do internship, postdoc, and likely a few years in a system job, they've likely forgotten a good deal of the info. I'm fine with this not being a required part of training in grad school, personally.

-I don't think it needs to be a formal part of a learning curriculum. We don't need a "Billing In Practice 101" for incoming students/trainees.

But for a part of that's so integral to how the system works (Just about everyone uses CPT codes), proper knowledge of how billing is structured and how we make our money is important to be aware of before going into the institutions that use them.

This could be as simple or broad as needed.
- As part of a student's practicum class, there could be an exercise/assignment that explores how your services are charged at your current practicum site.
- An optional didactic that brings in a previous alumni to speak to students about private practice and operations.
Etc. etc.

Point being, students, trainees, and recent grads are often unprepared for this aspect of the work, and we are more than prepared to address this.

 

[PsyDr]

Just wanted to add that if we require teaching it, it's now fair game for testing on it too.

Do you think it's advantageous to include questions on the EPPP related to business/practice management?

I support testing competencies for any area of practice that could wind you up in federal prison.

 

[Shiori]

We'd bring in people from the community to teach us different stuff that we wanted to know more about, but weren't fully fleshed out courses. We'd usually structure it as a lunch and learn. I would have been pretty interested to hear someone discuss the ins and outs of private practice during a lunch and learn.

If there is someone who has a relationship to the school, they might be down to do a quick training. I have gone and talked about my experiences as a VA psychologist to classes in the past. That seemed to go over well.

As a student, I also put together a small grant for some internal funding that was available because I wanted more information about DEI topics. We paid the speakers a couple hundred dollars and got it catered. It turned out well! I could totally see someone doing something similar for a mini private practice series.

 

[R. Matey]

FWIW, we had a business of counseling course in my master's program (developed due to similar complaints) and I feel like it did very little to actually prepare us for private practice. Beyond general principles about how to structure a business (which was of questionable use to a bunch 24-year-olds without a clinical license for the price of what we paid in graduate tuition), it didn't do much to teach us the ins-and-outs of actually running a business day-to-day. Much of running a business will depend on (1) the services you offer, (2) where and how you offer them, (3) how you market yourself, and (4) your personal risk tolerance. This was covered in our course, but from more of a "hey, marketing is a good idea" perspective, which anyone here can tell you for free.

Also, there is a Handbook of Private Practice written by a bunch of D42 psychologists that has a ton of useful information in it. From what I've seen on this board, it doesn't appear too outdated. Any interested student could always pick up a copy and plow through it during their summer term.

 

[oliversacks4thewin]

I support testing competencies for any area of practice that could wind you up in federal prison.

The EPPP already has an ethics/legal/professional issues section...

 

[PsyDr]

The EPPP already has an ethics/legal/professional issues section...

In this imaginary scenario, billing could be added to that section.

 

[R. Matey]

In this imaginary scenario, billing could be added to that section.

Are you saying that billing practices should take the place of two-factor theory of motivation?

 

[Therapist4Chnge]

The EPPP should drop any question about the Rorschach and replace them w some CPT questions.

 

[oliversacks4thewin]

The EPPP should drop any question about the Rorschach and replace them w some CPT questions.

While I don't disagree with you (anyone who personally knows me, knows how I feel about that "test" and Exner and his Barnum statement interpretations lol), I am not eager to upset the strong contingency of psychoanalysts in places like New York City. They'll riot, and worse they'll do it in a Freudian way. I can't think of a worse fate.

 

[Therapist4Chnge]

They’ll hold up “Your Mom!!” protest signs.

 

[Sanman]

The EPPP should drop any question about the Rorschach and replace them w some CPT questions.

I was going to literally type this word for word.

 

[Sanman]

They’ll hold up “Your Mom!!” protest signs.

 

[ThatPsyGuy]

They’ll hold up “Your Mom!!” protest signs.

And/or:

 

[WisNeuro]

While I don't disagree with you (anyone who personally knows me, knows how I feel about that "test" and Exner and his Barnum statement interpretations lol), I am not eager to upset the strong contingency of psychoanalysts in places like New York City. They'll riot, and worse they'll do it in a Freudian way. I can't think of a worse fate.

I would live to see this riot, consisting of mostly 75+ year old white men. It would be quite the self-masturbatory circle jerk

 

[PsyDr]

Are you saying that billing practices should take the place of two-factor theory of motivation?

In this scenario, I think we should place these questions in the same category as “dragon fighting” and “unicorn lasso’ing techniques”.

 

[oliversacks4thewin]

The worst part, is that I know when I walk past the sign of "Your Mom" they'll immediately start to analyze how and in what way I casually walked by the display of my mother, in a clearly dismissive fashion, representing gosh only knows what about that relationship lol.

 

[GT_Neuro]

This would be a very helpful course to take in graduate school. There is A LOT of information that you need to know to be successful in private practice.