Cash-only private practice -help with joining

[TaxiDriver]

I am trying to see if I am thinking of everything while I look for my job after my child psychiatry fellowship.

I am thinking of accepting a cash-only private practice that already has 4 MDs. They offer benefits (health, malpractice 401k etc). Their split is 60/40. They said they would fill my schedule with patients within 6-8 weeks, as this area is highly populated and has a lot of patients who are willing to see a fee-for service MD. (This is around the DC area). The practice's reputation is very good among the community and medical schools in the area. They said my fees for patients would start off "lower than others" in the beginning, and as I become board certified, etc, I can raise my fees. We did not discuss specific fees at this time. There seems to be a lot of competition for graduating fellows to get into a practice like this.

Am I thinking of all the correct things so far in regards to a job like this? There was no mention of an income guarantee that a lot of insurance places offer. Would this be a problem? It is a cash-practice, so fees are collected at time of service. Also, most all places also give health insurance for family members also, correct?

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[TexasPhysician]

It really depends on what fees they can guarantee.

If a new eval is $200 cash. You make $120/hour. Moonlighting residents can earn that much.

If a new eval is $320, you found a really good deal.

Can you not start a similar practice near by and keep 100% of billed services?

 

[LoudBark]

I am trying to see if I am thinking of everything while I look for my job after my child psychiatry fellowship.

They said my fees for patients would start off "lower than others" in the beginning, and as I become board certified, etc, I can raise my fees. We did not discuss specific fees at this time.
Am I thinking of all the correct things so far in regards to a job like this?

Your fees won't be lower, they are just going to take more of your fees for themselves. You need to be very, very, very careful. I have seen practices like this in many specialties.

You will basically be the partners biatch and they will be making money off of your for a set period of time.....or indefinitely. As a matter of fact, no one brings another doc into a group unless it has some financial benefit for themselves. Think about it. No one gets taken advantage more than young doctors right out of residency. You may know your psychiatry like the back of your hand....but you got a residency in psychiatry behind you....not an MBA. You are a prime target unfortunately to be taken advantage of financially.

 

[notdeadyet]

I am thinking of accepting a cash-only private practice that already has 4 MDs. They offer benefits (health, malpractice 401k etc). Their split is 60/40. They said they would fill my schedule with patients within 6-8 weeks, as this area is highly populated and has a lot of patients who are willing to see a fee-for service MD. (This is around the DC area). The practice's reputation is very good among the community and medical schools in the area. They said my fees for patients would start off "lower than others" in the beginning, and as I become board certified, etc, I can raise my fees. We did not discuss specific fees at this time.

If you haven't discussed fees, I'm not sure how you can be thinking of accepting an offer yet.

And when you say you would have "lower than others" fees, do they mean you will bill at a lower rate or you will get less than the 60/40 split (my hunch is it's the latter)? What is the timeline for when you will bill higher rates or get the full split?

It's tough to have an opinion of this without your specific market, but a 40% bite for office space and benefits doesn't sound like that great a deal depending on your billing rate. It might be a nice job to have for a year or so out of fellowship, but that doesn't sound like a great deal long-term depending on your billing. What's the non-compete clause like?

 

[J ROD]

Is there a partner track? 60/40 is too big a take for them.

They will set you up and make you their bitch to make money for them.

I dont like the sound of it.

I would look for something where I got an partner track and more concrete info and numbers.

 

[TaxiDriver]

Well, actually I am allowed to set my fees but the director would recommend my "starting" fees for me. The split is always 60/40, they don't take a larger cut in the beginning. The only thing so far is that I can raise my fees after I pass board exams (I just passed adult boards recently and will take child boards in Oct 2013). There is a partnership track after 2 years where you can buy-in and the split becomes 80/20 after that. All of the MDs have been at this practice for 3 years or more. I will ask about specific fees soon, such as what I can start off with. Filling the schedule with patients doesn't seem to be a problem in this high demographic area.

 

[jokerabc]

if there is a partnership track, then that's not bad. it seems as if most child psychiatrists are just trying to get into a cash-only private practice these days. at least in my area anyway. and the competition to get into a cash-only group practice is big. sure, you can get a job at a clinic that takes insurance and then you have to do 15 min med-checks.

i would seriously look into this offer and maybe talk to the other MDs in the group, not just the medical director.

 

[vistaril]

I am trying to see if I am thinking of everything while I look for my job after my child psychiatry fellowship.

I am thinking of accepting a cash-only private practice that already has 4 MDs. They offer benefits (health, malpractice 401k etc). Their split is 60/40.

that is terrible.....this isn't a pain medicine clinic or a dentist or whatever where they are letting you use their 50,000 dollar equipment to see patients and bill using that equipment for those procedures. They are providing you an office, and secretary, and patients initially....that is it. The idea that you're going to give them 40% to do that is absurd.....25-28% is more in line with the real world if you want to basically rent an office from them in such a setup.

 

[jokerabc]

that is terrible.....this isn't a pain medicine clinic or a dentist or whatever where they are letting you use their 50,000 dollar equipment to see patients and bill using that equipment for those procedures. They are providing you an office, and secretary, and patients initially....that is it. The idea that you're going to give them 40% to do that is absurd.....25-28% is more in line with the real world if you want to basically rent an office from them in such a setup.

i've seen the overhead around 25-30% for child psychiatrists out of fellowship taking a job that sees patients with insurance. I've seen overhead around 40% for these cash practices, that might get better with parntership or stays the same and the fees for patients just get higher. these docs still make around 300k.

 

[vistaril]

i've seen the overhead around 25-30% for child psychiatrists out of fellowship taking a job that sees patients with insurance. I've seen overhead around 40% for these cash practices,.

what is the rationale for increased overhead with cash practices? With a cash practice, there is less billing/insurance issues, which theoretically *reduces* overhead, so it seems like the percentage should be even lower for cash practices.

 

[jokerabc]

what is the rationale for increased overhead with cash practices? With a cash practice, there is less billing/insurance issues, which theoretically *reduces* overhead, so it seems like the percentage should be even lower for cash practices.

i'm not disagreeing with you. i wonder the same thing myself. this is just what i've seen in this area (NC and SC) for cash practices with child psychiatrists. i assume it's because so many people want to come join their clinic b/c it's "cash-only." that's the things to do these days. these are just my thoughts

 

[vistaril]

i'm not disagreeing with you. i wonder the same thing myself. this is just what i've seen in this area (NC and SC) for cash practices with child psychiatrists. i assume it's because so many people want to come join their clinic b/c it's "cash-only." that's the things to do these days. these are just my thoughts

there isn't any reason you can't open your own cash clinic and attract patients.....if you join their clinic, you are still going to eventually have to attract cash paying patients. Or keep the ones you initially get. Joining another practice may help initially in terms of having patients, but eventually cash paying patients are paying cash to see you....you either get them and keep them coming to see you, or you dont/cant. If you arent any good and patients dont see you as providing value for cash pay, they aren't going to say "well I don't my kids psychiatrist and feel silly paying out of pocket for his services, but because he is in this group where better psychiatrists are I'll still keep paying him"...

Furthermore, sometimes you can make more money in the outpt setting with insured patients. It is easy to stack up LARGE VOLUMES of adhd med refill patients with insurance. When people are paying cash, they are typically paying for a set amount of time and not going to accept being shuffled in and out in 4-5 minutes...which is the reality with some of the stable med check adhd patients. Keep in mind that in a cash pay clinic if you collect 1.35x an insured patient, you're still making less money if you could see 1.5x the same number of insured patients....

 

[PikminOC]

there isn't any reason you can't open your own cash clinic and attract patients.....if you join their clinic, you are still going to eventually have to attract cash paying patients. Or keep the ones you initially get. Joining another practice may help initially in terms of having patients, but eventually cash paying patients are paying cash to see you....you either get them and keep them coming to see you, or you dont/cant. If you arent any good and patients dont see you as providing value for cash pay, they aren't going to say "well I don't my kids psychiatrist and feel silly paying out of pocket for his services, but because he is in this group where better psychiatrists are I'll still keep paying him"...

Furthermore, sometimes you can make more money in the outpt setting with insured patients. It is easy to stack up LARGE VOLUMES of adhd med refill patients with insurance. When people are paying cash, they are typically paying for a set amount of time and not going to accept being shuffled in and out in 4-5 minutes...which is the reality with some of the stable med check adhd patients. Keep in mind that in a cash pay clinic if you collect 1.35x an insured patient, you're still making less money if you could see 1.5x the same number of insured patients....

Thank you everyone for all your great posts.
The problem with insurance, is it's not only about the cost. The insurance contract has ALOT of rules you have to adhere to, that you don't have to adhere to with cash patients. Plus the aggravation of billing the insurance company, then fighting with them for compensation, then rebilling...and on and on..which is why you have to pay for more staff as well.
You would be surprised at some of the insurance patients getting pisd if you shuffle them in and out. If anything I have noticed the mcare/aid patients demanding the most out of me and saying to me "this is what a i pay you for"...

I am joining a group but I am an indept contractor. I really like the safety of having staff present, and they know how to deal with psych patients. I don't have to oversee EVERYTHING like I would if I opened my own practice. Also, while I am building up a practice, the overhead to open my own place would be prohibitive. I think a 30-40% cut is fair, and like everything, can be renegiotiated as I become more needed at the practice.

In psychiatry, it is possible to get cash paying patients and setting limits. I charge for prior auths, extra time, missed appts, paperwork, letters etc. You can't always do this with insurance patients. So 1.5 insurance patients there is alot more aggravation as well.

 

[PikminOC]

Thank you everyone for all your great posts.
The problem with insurance, is it's not only about the cost. The insurance contract has ALOT of rules you have to adhere to, that you don't have to adhere to with cash patients. Plus the aggravation of billing the insurance company, then fighting with them for compensation, then rebilling...and on and on..which is why you have to pay for more staff as well.
You would be surprised at some of the insurance patients getting pisd if you shuffle them in and out. If anything I have noticed the mcare/aid patients demanding the most out of me and saying to me "this is what a i pay you for"...

I am joining a group but I am an indept contractor. I really like the safety of having staff present, and they know how to deal with psych patients. I don't have to oversee EVERYTHING like I would if I opened my own practice. Also, while I am building up a practice, the overhead to open my own place would be prohibitive. I think a 30-40% cut is fair, and like everything, can be renegiotiated as I become more needed at the practice.

In psychiatry, it is possible to get cash paying patients and setting limits. I charge for prior auths, extra time, missed appts, paperwork, letters etc. You can't always do this with insurance patients. So 1.5 insurance patients there is alot more aggravation as well.

I was wrong. The head of the group, a SW, said I was an indept contractor, but also an employee. You cant be both. So I left.

 

[TexasPhysician]

I was wrong. The head of the group, a SW, said I was an indept contractor, but also an employee. You cant be both. So I left.

The number of people that try to take advantage of young docs is astounding. I'm always looking for the catch. Just be glad you are learning the ropes early. You'll be better off in the long run. Good luck on your next endeavor.

 

[vistaril]

So wait...you are giving the group up to 40% of your collections, and these are cash pay patients? Under that scenario, they better be the ones providing you with these cash paying patients and guaranteeing you a certain amount of volume....because if you have to recruit them and fill your schedule yourself, that seems way too much in a cash pay system.....

Finally, what are you planning to offer these patients such that they are going to pay extra(since they are bypassing insurance).....

 

[michaelrack]

Finally, what are you planning to offer these patients such that they are going to pay extra(since they are bypassing insurance).....

Cash pay is the standard in a few areas. What is being offered is that the patient is being seen in a nice office, rather than having to do go down to the community mental health center and wait in line with those with medicare/medicaid.

 

[michaelrack]

I am getting confused. Are TaxiDriver and GroverPsychMD the same person?

 

[splik]

Finally, what are you planning to offer these patients such that they are going to pay extra(since they are bypassing insurance).....

you don't necessarily have to offer anything extra, the discretion of off-the-radar care may be enough if that is important, if you don't want any mention of these problems on your insurance, in your medical records etc. i hope i never get ill in this country, (either physically or mentally) but if i were going to see a psychiatrist i sure as hell would not be doing it through my insurance.

 

[psychiatrist20]

Does anyone know the going hourly rates for BC independent contracting psychiatrists? I know that there can a lot factors involved that would affect the amounts but does anyone have a general ballpark. There are many sources for salary information out there but none that I have seen specific for independent contracting. I was offered an independent contracting position for 20 hrs/week at $115/hr and I am board-certified. At first look anything over $100/hr seems good but taking into account that there are no benefits and additional costs such as medical malpractice,etc this deal may not be very good. Any input would be appreciated.

 

[TexasPhysician]

Does anyone know the going hourly rates for BC independent contracting psychiatrists? I know that there can a lot factors involved that would affect the amounts but does anyone have a general ballpark. There are many sources for salary information out there but none that I have seen specific for independent contracting. I was offered an independent contracting position for 20 hrs/week at $115/hr and I am board-certified. At first look anything over $100/hr seems good but taking into account that there are no benefits and additional costs such as medical malpractice,etc this deal may not be very good. Any input would be appreciated.

It probably depends on location, but as a 2nd year resident, I made over $100/hour.

 

[PikminOC]

I am getting confused. Are TaxiDriver and GroverPsychMD the same person?

I do not have two accounts. It is hard enuf keeping track of one.

I am happy other ppl are asking questions about this stuff...as we all need to figure these issues out..

I offer my BC psychiatric services..I am in an underserved area...very few shrinks here..esp ones that will see adolescents..

 

[michaelrack]

Does anyone know the going hourly rates for BC independent contracting psychiatrists? I know that there can a lot factors involved that would affect the amounts but does anyone have a general ballpark. There are many sources for salary information out there but none that I have seen specific for independent contracting. I was offered an independent contracting position for 20 hrs/week at $115/hr and I am board-certified. At first look anything over $100/hr seems good but taking into account that there are no benefits and additional costs such as medical malpractice,etc this deal may not be very good. Any input would be appreciated.

100$ per hour (approx 200,000/yr) would be on the low end for an employed position for a BC psychiatrist with minimal call and good benefits.

For an independent contractor position, you should be looking for at least 15% higher to make up for the self-employment tax, lack of benefits, need for malpractice, etc.

Unless this job was attractive to you for other reasons (flexible hours, etc), I would recommend not doing it for less than $125/hr.

Alternatively, if this job does not require a long-term committment (if it is a locums type job), you could offer to start off at $115/hr for the first month with salary to be renegotiated once they see how good you are (this strategy only works in limited circumstances, for "side jobs")

 

[vistaril]

Cash pay is the standard in a few areas. What is being offered is that the patient is being seen in a nice office, rather than having to do go down to the community mental health center and wait in line with those with medicare/medicaid.

cash pay is not the standard though for high volume outpt med mgt. Your example presents two extremes.....as if the option is a cmhc vs a cash pay clinic for these insured patients. In many areas there are no shortage of psychiatrists doing high volume med mgt taking blue cross, humana, aetna, etc....in fact there is a generally a good deal of competition for those pts.

 

[vistaril]

you don't necessarily have to offer anything extra, the discretion of off-the-radar care may be enough if that is important, if you don't want any mention of these problems on your insurance, in your medical records etc. i hope i never get ill in this country, (either physically or mentally) but if i were going to see a psychiatrist i sure as hell would not be doing it through my insurance.

I don't think many patients feel that way, especially the non-smi population. And if they are smi, they likely arent going to be cash pay type patients anyway. The stigma of being on an antidepressant now just isn't very big these days.

Most of the people I know doing cash pay are analyst types which by the nature of the care neccessitates it.

I do know of one guy who operates cash pay in a med mgt type practice model, but his rates are so low(nothing close to the analyst types) that the pts aren't likely to be bothered by it because in some cases his rates arent much more than the copay they would pay somewhere else. He has a fairly well off wife and I suppose he can do this because she is the principal income. But if he raised his rates to the rates of the analysts in town(and still kept practicing the same way), he wouldnt have many patients.

 

[michaelrack]

cash pay is not the standard though for high volume outpt med mgt. Your example presents two extremes.....as if the option is a cmhc vs a cash pay clinic for these insured patients. In many areas there are no shortage of psychiatrists doing high volume med mgt taking blue cross, humana, aetna, etc....in fact there is a generally a good deal of competition for those pts.

Well, I did specifically use the word "few". But I agree that this is not the standard for a high volume practice- the cash pay psychiatrists I know are reputable practitioners and see 2-3 patients per hour. I imagine that if you are liberal with controlled substances, a cash pay psychiatrist could probable get away with 4 patients per hour in some areas.

 

[PikminOC]

Well, I did specifically use the word "few". But I agree that this is not the standard for a high volume practice- the cash pay psychiatrists I know are reputable practitioners and see 2-3 patients per hour. I imagine that if you are liberal with controlled substances, a cash pay psychiatrist could probable get away with 4 patients per hour in some areas.

i am not looking for high volume...
im not liberal with controlled subs..
its just the way i am...

 

[vistaril]

i am not looking for high volume...
im not liberal with controlled subs..
its just the way i am...

so Im curious.....how many patients are you planning to see an hour? And what are your cash pay rates?

 

[PikminOC]

2 - 3 per hour
$250 per intake (60 minutes)
$100 for 20 min fup
$150 for 30 min fup
Patients can use their out of network benefits.
I give them a billing sheet.

I have worked in too many places I hate- CMHC, employee, etc..
So we will see.
Every area is different.

 

[vistaril]

2 - 3 per hour
$250 per intake (60 minutes)
$100 for 20 min fup
$150 for 30 min fup
Patients can use their out of network benefits.
I give them a billing sheet.

I have worked in too many places I hate- CMHC, employee, etc..
So we will see.
Every area is different.

yeah, good luck. When you enter the world of cash pay, it's all about whether patients want to pay to see you or not. If you are providing them a service that they feel is worth it, they will.

How many patients do you on your books so far who are paying that in cash money for non dynamic work?

 

[PikminOC]

What is non dynamic work?

 

[vistaril]

What is non dynamic work?

psychodynamic psychotherapy.....seems like a lot of the patients who are self pay are engaged in this. It makes a complete selfpay practice more sustainable simply because you need *fewer* total self pay patients due to the frequency of appts.....

I know one person who does that, and his schedule is full.....with self pay patients. He only has ~25 patients at any given time. And yet all his slots are booked.

By comparison, if some of the high volume med mgt outpt guys switched over to self pay patients, for their whole practice to be self pay they would need 5-600 patients.......that's a heck of a lot of self pay patients(assuming all arent on xanax and adderall)

 

[kindasorta]

Do you think any residency will prepare you well enough to do psychodynamic psychotherapy? I realize it's an ongoing skill, but at least the foundations.

 

[splik]

Do you think any residency will prepare you well enough to do psychodynamic psychotherapy? I realize it's an ongoing skill, but at least the foundations.

Technically, the ACGME requirements are for 'competency' in supportive, psychodynamic, and cognitive-behavioral therapy. The question really is what do we mean by competency (there are defined competencies but different programs have interpreted this in different ways). Many will argue it is not possible to get really good in psychodynamic therapy during residency, whilst others say you should have a good foundation to work on. Regardless, if you are interested in this you should elect to do further training at the local analytic institute (not necessarily analytic training you can do a certificate course) attend the american psychoanalytic association annual meeting, take on a good case load of a variety of different cases, do wider reading including classic texts, read the journal of the american psychoanalytic association, and have your own personal therapy. it is also possible to do fellowship training in this area (for example cambridge health alliance, austen riggs etc).

Here is an interesting article debating whether or not psychodynamic therapy should or even can be a legitimate competency for residency.

One interesting point is there no such competency requirement for clinical psychologists. Many, if not most, clinical psychologists will not be trained in psychoanalytic/dynamic therapy (unless they are in new york) or happen to elect further training.

 

[vistaril]

If someone is the best trained/most skilled analyst in the world, if they can't market themselves and attract/keep self pay patients, they aren't going to do well. Whereas if someone is a crappy analyst with no additional dynamic training outside of residency(and didn't put a lot of effort into it), if they can do whatever it takes to attract and keep self pay patients then they are doing well.

Now obviously it can be argued that a very skilled analyst is more likely to attract and keep self pay patients than a bad one, but it isn't really this simple. In self pay psychiatry, it really is irrelevant why the patient is seeing you.....maybe it's because you are a good analyst, or maybe it's because you do a juggling act to close each session the pt finds amusing. If you want to call yourself an analyst and do self pay and then spend the session debating whether ron guidry should be in the baseball hall of fame, then that's all fine.....as long as you can get someone to pay for it

 

[PikminOC]

If someone is the best trained/most skilled analyst in the world, if they can't market themselves and attract/keep self pay patients, they aren't going to do well. Whereas if someone is a crappy analyst with no additional dynamic training outside of residency(and didn't put a lot of effort into it), if they can do whatever it takes to attract and keep self pay patients then they are doing well.

Now obviously it can be argued that a very skilled analyst is more likely to attract and keep self pay patients than a bad one, but it isn't really this simple. In self pay psychiatry, it really is irrelevant why the patient is seeing you.....maybe it's because you are a good analyst, or maybe it's because you do a juggling act to close each session the pt finds amusing. If you want to call yourself an analyst and do self pay and then spend the session debating whether ron guidry should be in the baseball hall of fame, then that's all fine.....as long as you can get someone to pay for it

Many PP psychiatrists don't accept insurance. And patients are annoyed with the care in hospital clinics and the 10-15 minutes they get from their provider.

The patients that have insurance can use their OON benefits. They can file it themselves with my coding sheet.

The patients who do have insurance, can't find PP psychiatrists to take them as they are full. And many of them really value privacy and don't want 200 people (coders, billers, secretaries) to know they are seeking help.

http://clearlifepath.org/
This doc does do analysis, but not every doc with this model does it.

 

[vistaril]

Many PP psychiatrists don't accept insurance. And patients are annoyed with the care in hospital clinics and the 10-15 minutes they get from their provider.

The patients that have insurance can use their OON benefits. They can file it themselves with my coding sheet.
QUOTE]

I realize this is a popular way to go, but a lot of insurance companies won't accept this method. And then there are usually in network/out of network issues too.

So how is it going with your practice set up that way so far? How many patients are you seeing a day and what are your total collections?

 

[PikminOC]

It is going well thank you for asking. I have time with my patients, I am happier seeing patients who want to see me. I have worked as a hospital employee and at a county facility, done ip and outpt and consult work, and this PP makes me feel the most fulfilled.

Everyone is different, keep on grinding if thats what you like to do.

 

[vistaril]

It is going well thank you for asking. I have time with my patients, I am happier seeing patients who want to see me. I have worked as a hospital employee and at a county facility, done ip and outpt and consult work, and this PP makes me feel the most fulfilled.

Everyone is different, keep on grinding if thats what you like to do.

but Im curious, what sort of numbers are you generating? How much is your rent? Any staff?

 

[PikminOC]

I do everything on my own. Scheduling, screening calls, billing and collecting. I rent space. It is cheap and I am happy.

I am glad I had those other experiences too.

 

[jumpbean2]

I do everything on my own. Scheduling, screening calls, billing and collecting. I rent space. It is cheap and I am happy.

I am glad I had those other experiences too.

Glad to hear your enjoying your PP. Would you mind elaborating on your daily schedule? How many hours a day are you seeing patients? How many hours a day do you devote to administration and paperwork? Side note- isn't 250 for a 60 minute intake on the lower side?

 

[PikminOC]

Thank you for asking jumpbean.

I have a flexible schedule. I work in different places. But I have enuf income to allow my private practice to grow slowly.

It is not on the lower side for the rural town I am in. People are so used to using their insurance, they are pissed when it is more than $40 (their copay with their insurance). I really really dont want to take any insurances.

I am still working on the administrative side. I am using paper charts, which take considerably less time, but are unwieldy. I am trying to find good practice software, so any help would be appreciated. Still working things out.

 

[markglt]

what else do you do?

 

[markglt]

i ask this with ignornce as to how the real PP attending world works...however, would ur practice paradigm and holding a postion as a medical director of a private rehab work?

 

[vistaril]

It is not on the lower side for the rural town I am in. People are so used to using their insurance, they are pissed when it is more than $40 (their copay with their insurance). .

why is why self pay psychiatrists, if they are going to thrive, have to be providing a service that easily exceeds that of a psychiatrist taking insurance. To the point that the patient values it so much that they are willing to pay extra cash money for it. That's a high standard.

If I was a patient, and was paying someone 150 bucks for 25 minutes, they better blow me away with their skill set and expertise and what they are doing for me that someone who is taking my insurance can't.

 

[vistaril]

Glad to hear your enjoying your PP. Would you mind elaborating on your daily schedule? How many hours a day are you seeing patients? How many hours a day do you devote to administration and paperwork? Side note- isn't 250 for a 60 minute intake on the lower side?

250 dollars is most certainly not low for a 60 minute intake....it is actually fairly high.

 

[PikminOC]

i ask this with ignornce as to how the real PP attending world works...however, would ur practice paradigm and holding a postion as a medical director of a private rehab work?

I will PM you.

 

[F0nzie]

People are so used to using their insurance, they are pissed when it is more than $40 (their copay with their insurance).

Psychiatrist A: 60 minutes ($40 copay). Psychiatrist B: 60 minutes ($250). hmm...

 

[vistaril]

Psychiatrist A: 60 minutes ($40 copay). Psychiatrist B: 60 minutes ($250). hmm...

that's why psychiatrist B better walk on water and show me things that will make obvious and meaningful improvements relative to psychiatrist A. And let's be honest, the vast majority of psychiatrists out there aren't that much better than the guys who do take insurance(which are most psychiatrists).......

there is *competition* out there for insured pts in most areas for med mgt. There are tons of decent psychiatrists in the community who feel pressured to dole out stims for very questionable adhd cases and pass out some benzos to keep *insured* pts coming back....

In many areas, the difference between a lot of the cash pay guys and the take insurance guys are the following:

-the insurance guys will give out small doses of stims for some questionable adhd cases if they don't have a super sketchy feel about it. and they may say no to some. Also, they will not increase the dose crazily and will check monitoring databases and dot the i's. For benzos they do low doses and prns, and set reasonable limits.
-the cash guys typically have jacked up regimens like Xanax 2mg TID and Adderall instant release 80-90mg a day total.....and pretty much don't give a flip about monitoring to any extent. In fact, they would rather not find out about reasons to no longer prescribe because that would create a bunch of hassles for them.

now, this obviously doesn't include the cash guys who cater to very sophisticated and affluent patients who feel that the person is a great psychiatrist. But this is usually dynamic therapy(or at least based on such) and doesn't really have a med mgt focus at all. A different category all together.

Any cash pay psychiatrist who is not an expert columbia trained analyst who also has additional analytical training who can draw pts that way or is not an extreme candyman(ie 6-8 mg xanax today + 90mg of adderall per day) simply doesnt have a compelling case to attract self pay patients over other psychiatrists.

 

[Socrates25]

I'm going to chime in here. I'm not psych (I'm peds) but in my area (Austin TX) child psychiatrists are so rare and hard to come by that I think a child psychiatrist could EASILY set up a lucrative cash only practice and fill his appointment slots by day #1. I cant speak to adult psych but I know when I try to refer a child to psych it takes at least 8 months to get them in somewhere.

Out of all the different peds subspecialists, child psych is the hardest to get someone in a timely manner. You guys should be able to take advantage of that.