work load

[PSYD2024]

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how are folks/are folks managing to work full time (in va's, ucc's, cmhc, etc) and maintaing a private practice load on the side?

 

[AcronymAllergy]

Essentially the only answer is that your PP work is done outside your standard work shift; meaning that almost all of those folks are working >40 hours/week. I imagine the majority fit their PP work on nights and/or weekends (and those hours can often work better for patients anyway), although if you have a 4-10's schedule, then you can just devote that fifth day (and then some) to the PP.

 

[psy.d. 2021]

Essentially the only answer is that your PP work is done outside your standard work shift; meaning that almost all of those folks are working >40 hours/week. I imagine the majority fit their PP work on nights and/or weekends (and those hours can often work better for patients anyway), although if you have a 4-10's schedule, then you can just devote that fifth day (and then some) to the PP.

This is it. So the answer is basically coffee

 

[PSYD2024]

This is it. So the answer is basically coffee

so burnout then. got it

 

[psy.d. 2021]

so burnout then. got it

Working two jobs has a tendency to do that.

 

[Sanman]

so burnout then. got it

Burnout depends on personal circumstances. I used to work 60 hrs/wk as a young single person. As a middle aged parent, not so much.

 

[AcronymAllergy]

so burnout then. got it

Not necessarily, but it's one factor that could contribute. Not really sure what other answer/solution there is than working more hours.

 

[Harry3990]

I work 80% FTE, so 32 hours per week at my hospital job and that leaves more room for PP and other side work. I think another factor that helps with this equation is more often these days people are able to negotiate wfh days which also mean that it is a lot easier to squeeze in a PP patient or two just at the end of your remote work without a commute disrupting the flow.

So it’s definitely doable without burnout. You just have to be intentional about it and have solid boundaries. Another example of a colleague that comes to mind is just having a single night per week that they work PP in addition to 40 hr job. That for them means 1 rather long day but is sustainable for them because otherwise they are 8-4.

 

[PsyDr]

1) Get the notes done in session. If you can't do that, consider reducing the information in your notes. There is a reason that psychotherapy side gigs are more common than paperwork heavy gigs.
2) Remind me, what's that cognitive distortions where someone says "This outcome is a definitive evitability."? (hint hint)
3) Burnout is caused by low social support, a lack of control relative to reward, and some other factors. You are literally in control of your schedule in PP. If you're getting burnt out, then gradually reduce your work until you can handle things, maintain social supports, EXERCISE, etc.
4) IME with burnout, some distress can be caused by a failure to truly accept the life you chose. You've chosen to work late. Normal life responsibilities don't change because you changed. How have you accommodated those life responsibilities now that you have a NEW schedule? Are you trying to work until 9pm M-F, and then expect to have normal Saturday & Sunday? Are you expecting your best performance levels on your average day, or are you accounting for low productivity days? What is your schedule for chores? What are your social responsibilities, and how much do you care about that? Thorough planning can make this very easy.
5) Is additional work worthwhile? I would recommend looking at your living expenses BEFORE PP, and AFTER PP, to see if it is worth it. Are you ordering grocery deliveries, Ubereats or Amazon stuff more? Are you sending your laundry to the cleaners more? My expenses significantly change around 70hrs/wk. That has to be taken into account, when deciding about if the money is worth it.
6) What is your long term purpose for this side PP? If it's just money, you should be able to explain the specific amount you want, and the money's specific purpose.

 

[smalltownpsych]

how are folks/are folks managing to work full time (in va's, ucc's, cmhc, etc) and maintaing a private practice load on the side?

I personally could not do it, but all of my jobs have been clinical and highly demanding. I also do best when my cognitive load is more focused. If not, I get scattered and begin letting things slide or pile up. Even trying to balance clinical and admin in my one job is a lot. As Clint Eastwood said in Dirty Harry right before blowing someone’s brains out, “a man has to know his limitations.”

 

[Sanman]

I personally could not do it, but all of my jobs have been clinical and highly demanding. I also do best when my cognitive load is more focused. If not, I get scattered and begin letting things slide or pile up. Even trying to balance clinical and admin in my one job is a lot. As Clint Eastwood said in Dirty Harry right before blowing someone’s brains out, “a man has to know his limitations.”

I can't imagine doing what you do in PP as a side gig. However, most folks I know with one are doing 2-4 outpatient cash clients/wk. Sometimes virtual and before the pandemic in person. Also depends on your day job.

 

[DynamicDidactic]

Anecdotally, the folks I know that have a 9-5 day job pick an evening out of the week and do remote private practice. If you are able to take on 4 patients from 5-9, one night a week, that seems rather doable. Perhaps doing that two days a week is also doable. But more than that seems like asking for trouble (even without a family and other life responsibilities).

I have an academic job, which gives me flexibility to see a handful of clients throughout the week without having to stack them in the evenings.

 

[Shiori]

I see a max of four private practice clients a week on weekend mornings. At my VA, the client population is very narrow and that has been burning me out. My private practice allows me to see a wider variety of clients, so I get to mix things up. I also have an escape route if I ever need it. That has added some peace of mind.

 

[PsyDr]

I see a max of four private practice clients a week on weekend mornings. At my VA, the client population is very narrow and that has been burning me out. My private practice allows me to see a wider variety of clients, so I get to mix things up. I also have an escape route if I ever need it. That has added some peace of mind.

You are one of the rare people that makes Saturday appointments work. Please consider putting some advice in the PP thread. You're clearly doing something right.

 

[Shiori]

You are one of the rare people that makes Saturday appointments work. Please consider putting some advice in the PP thread. You're clearly doing something right.

Haha, really? I had no idea I was doing something special. It was just the only time that worked for me. I tend to get a lot of parents or people who work overnight.

 

[cara susanna]

I see a max of four private practice clients a week on weekend mornings. At my VA, the client population is very narrow and that has been burning me out. My private practice allows me to see a wider variety of clients, so I get to mix things up. I also have an escape route if I ever need it. That has added some peace of mind.

Do you work for someone else's practice or do you run your own?

It would be nice to get some PP experience even now while working at the VA, but I just love my free time too much.

 

[PsyDr]

Haha, really? I had no idea I was doing something special. It was just the only time that worked for me. I tend to get a lot of parents or people who work overnight.

Every "weekend session-er" that I have met says it's a waste of time, due to high no show rates. My personal experience is limited to hospitals, so IDK.

 

[AcronymAllergy]

Every "weekend session-er" that I have met says it's a waste of time, due to high no show rates. My personal experience is limited to hospitals, so IDK.

I remember when I was at VA, they started offering half-day appointments (I think just MH and primary care) on Saturdays. They stopped after a little while because hardly anyone ever showed up. But I could see it maybe being more successful with a private practice patient base, especially for telehealth.

 

[Sanman]

I remember when I was at VA, they started offering half-day appointments (I think just MH and primary care) on Saturdays. They stopped after a little while because hardly anyone ever showed up. But I could see it maybe being more successful with a private practice patient base, especially for telehealth.

I think it really depends on the patient base. We had a Saturday clinic at one of my VAs that seemed to always be booked solid. However, demand was high overall and there were plenty of folks with jobs. I cant see it being very popular with the disability crowd. In my experience, parents love weekends and after 3pm appts. My PP in the suburbs had high demand for weekends. Folks I knew in the city had no problems filling M-F from 9-5.

 

[Shiori]

Do you work for someone else's practice or do you run your own?

It would be nice to get some PP experience even now while working at the VA, but I just love my free time too much.

I just do Alma at the moment. Last year was my first year doing private practice and I wanted to make sure I liked it before fully committing. It's been a lot of fun, so I will probably try to panel with Aetna and BCBS myself and drop Alma next year. They were just acquired, so I think the party of decent reimbursement rates and autonomy will be over soon. This helped me get over my jitters though.

 

[Shiori]

Every "weekend session-er" that I have met says it's a waste of time, due to high no show rates. My personal experience is limited to hospitals, so IDK.

That's unfortunate. I did have a couple of folks oversleep, but it's mostly been good.

 

[Therapist4Chnge]

Haha, really? I had no idea I was doing something special. It was just the only time that worked for me. I tend to get a lot of parents or people who work overnight.

Oh yeah, Sat appointments are like gold. I’m unwilling to offer them, outside of the occasional IME bc they pay so well the hassle is worth it most of the time. I enjoy traveling, so Fridays have been “catch up” days for years. I sometimes will see morning patients, but I like having Friday open to do last minute legal work and/or fly out for a long weekend. I used to do more remote work, so I could work w my laptop wherever, and I’m trying to get back to that.

 

[cara susanna]

I think it really depends on the patient base. We had a Saturday clinic at one of my VAs that seemed to always be booked solid. However, demand was high overall and there were plenty of folks worh jobs. I cant see it being very popular with the disability crowd. In my experience, parents love weekends and after 3pm appts. My PP in the suburbs had high demand for weekends. Folks I knew in the city had no problems filling M-F from 9-5.

We got rid of our Saturday clinic because no one was using it.

 

[Sanman]

We got rid of our Saturday clinic because no one was using it.

We got rid of ours because no one wanted to work it.

 

[PsyDr]

@Shiori tell us your ways.

 

[Shiori]

@Shiori tell us your ways.

I wish I had a secret to share. I am Black and do a lot of minority stress work in a red state. I keep things fairly structured with CBT or ACT. During my consults, I'm upfront about wanting to be efficient with my clients' time, so maybe they're respectful of mine too? That's my best guess.

 

[Sanman]

I wish I had a secret to share. I am Black and do a lot of minority stress work in a red state. I keep things fairly structured with CBT or ACT. During my consults, I'm upfront about wanting to be efficient with my clients' time, so maybe they're respectful of mine too? That's my best guess.

Meanwhile, at the VA, I am waiting on someone that is about to no show me for the third time in four sessions.

 

[Shiori]

Meanwhile, at the VA, I am waiting on someone that is about to no show me for the third time in four sessions.

I think my VA experiences aggressively inform how I structure my private practice consults.

 

[WisNeuro]

Meanwhile, at the VA, I am waiting on someone that is about to no show me for the third time in four sessions.

Tell that Vet to pull themselves up by the bootstraps and stop contributing to waste/fraud/abuse! It's what they voted for!

In seriousness, at least you're salaried when in a high no-show system.

 

[Sanman]

Tell that Vet to pull themselves up by the bootstraps and stop contributing to waste/fraud/abuse! It's what they voted for!

In seriousness, at least you're salaried when in a high no-show system.

Yeah, I could not see these types of folks in private practice. Maybe some younger healthy retirees, but not these older sicker folks that are very inconsistent and frequently in and out of the hospital.

 

[psy.d. 2021]

Yeah, I could not see these types of folks in private practice. Maybe some younger healthy retirees, but not these older sicker folks that are very inconsistent and frequently in and out of the hospital.

You really can't because then it impacts you financially. It sucks to say hur that's the reality.

 

[WisNeuro]

Yeah, I could not see these types of folks in private practice. Maybe some younger healthy retirees, but not these older sicker folks that are very inconsistent and frequently in and out of the hospital.

It's more the VA mindset than their age and conditions. These folks rarely no show out here in the private sector, my long-term clinical no-show rate is low single digits, but most of those have been hospitalizations, and death in one instance.

 

[Sanman]

It's more the VA mindset than their age and conditions. These folks rarely no show out here in the private sector, my long-term clinical no-show rate is low single digits, but most of those have been hospitalizations, and death in one instance.

Mindset is a part of it and may lead to more poor outcomes and hospitalizations. However, hospitalizarion is still is still hospitalization for that group. The other part is a lack of finances and social support.

 

[PsyDr]

You really can't because then it impacts you financially. It sucks to say hur that's the reality.

Yeah you can. It's a simple matter of risk: reward.

Example A: A new patient is informed that your next appointment availability is in 6 months (ie., You are valuable.) Patient is offered placement on a contact list if someone no shows (ie, If you miss, it doesn't hurt us at all). Patient signs intake stuff agreeing to a $20 no show fee (ie. now there is some skin in the game). Someone no shows. Your front desk person fills in the appointment from the list AND you get an additional $20.

Example B: A new patient is informed that your schedule is wide open (ie., no one wants your services). Patient signs intake forms that do not penalize no shows (ie., there is zero risk to them no showing). Patient no shows and you just reschedule them without a "cost" to them (ie., teaching patients how to treat you). You lose the income from the appointment, and the time you could have dedicated to something else.

 

[Sanman]

Yeah you can. It's a simple matter of risk: reward.

Example A: A new patient is informed that your next appointment availability is in 6 months (ie., You are valuable.) Patient is offered placement on a contact list if someone no shows (ie, If you miss, it doesn't hurt us at all). Patient signs intake stuff agreeing to a $20 no show fee (ie. now there is some skin in the game). Someone no shows. Your front desk person fills in the appointment from the list AND you get an additional $20.

Example B: A new patient is informed that your schedule is wide open (ie., no one wants your services). Patient signs intake forms that do not penalize no shows (ie., there is zero risk to them no showing). Patient no shows and you just reschedule them without a "cost" to them (ie., teaching patients how to treat you). You lose the income from the appointment, and the time you could have dedicated to something else.

In this case, incentives make it so that those folks will likely not show up and pay the fee, so self-select out. The problem with the VA is that we can't charge money or enforce consequences, they make rules to accommodate late folks , and then blame providers for productivity problems. Either way, in PP, I would not be seeing these folks. I would be seeing those with better time management skills and who are likely more compliant with care recs and have better support.

 

[psy.d. 2021]

In this case, incentives make it so that those folks will likely not show up and pay the fee, so self-select out. The problem with the VA is that we can't charge money or enforce consequences, they make rules to accommodate late folks , and then blame providers for productivity problems. Either way, in PP, I would not be seeing these folks. I would be seeing those with better time management skills and who are likely more compliant with care recs and havexbetter support.

I've had people (I'm at VA) not agree to comm care because they just wanted a credit card on file. Lol

 

[cara susanna]

I think that if we charged for no shows and late cancellations, that would make a pretty big difference

 

[psy.d. 2021]

I think that if we charged for no shows and late cancellations, that would make a pretty big difference

For two reasons

One a lot of people would stop coming

Two there would be riots

 

[WisNeuro]

For two reasons

One a lot of people would stop coming

Two there would be riots

People need to have accountability for their actions!! Well....I didn't mean me.