Opinions on new pay scale

[texanpsychdoc]

As a private practice owner, I have hired on 3 new contractors with a possible 4th in the pipeline. With this in mind, I have to consider more innovative and mutually beneficial methods to earn more passive income while also balancing the fact of keeping my contractors to ensure they feel respected, have a sense of agency, have autonomy, and importantly, earn higher salaries than what they might get working for an organization such as the VA or an AMC.

Thus far, the current strategy has been to pay my contractor 75% of their earnings, and I keep 25%. I have recently modified my contract and advertisement so that any new folks I bring on board will keep 70% and I keep 30%. For example, if I have my contractors see 25 patients a week. with the patient being charged $124 per session, then they are keeping $93 of that billable. Rather than keep a stagnant rate, I had a thought of having a tiered system such as the following:

If contractor sees 1-20 patients a week, they keep 70%, if they see 21-25 patients a week, they keep 75%, if they see 26+ patients a week, the keep 80%. The reason behind this proposal is it helps incentive folks to see more people throughout the week and also can help stabilize a nice passive stream of income for myself.

If I had 5 contractors each seeing 25 patients a week, and they worked a 40 week work year, I would earn $179,800 in passive income.

Thoughts on this?

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[smalltownpsych]

As a private practice owner, I have hired on 3 new contractors with a possible 4th in the pipeline. With this in mind, I have to consider more innovative and mutually beneficial methods to earn more passive income while also balancing the fact of keeping my contractors to ensure they feel respected, have a sense of agency, have autonomy, and importantly, earn higher salaries than what they might get working for an organization such as the VA or an AMC.

Thus far, the current strategy has been to pay my contractor 75% of their earnings, and I keep 25%. I have recently modified my contract and advertisement so that any new folks I bring on board will keep 70% and I keep 30%. For example, if I have my contractors see 25 patients a week. with the patient being charged $124 per session, then they are keeping $93 of that billable. Rather than keep a stagnant rate, I had a thought of having a tiered system such as the following:

If contractor sees 1-20 patients a week, they keep 70%, if they see 21-25 patients a week, they keep 75%, if they see 26+ patients a week, the keep 80%. The reason behind this proposal is it helps incentive folks to see more people throughout the week and also can help stabilize a nice passive stream of income for myself.

If I had 5 contractors each seeing 25 patients a week, and they worked a 40 week work year, I would earn $179,800 in passive income.

Thoughts on this?

Sounds like a fairly good strategy. With some of this stuff you just have to roll it out and see if it works and then tailor it as you go. A good business leader doesn’t overthink before trying out new strategies and then is flexible enough to adjust as they implement, but is also cautious to not bend at every employee or contractors whim. Good luck!

My strategy is completely different. I just got another intensive outpatient type patient that I am going to bill 3200 a month for wrap around services and I use 25 an hour interns to help me out with these patients. That would bring the total monthly revenue from that aspect of my business to about 14k a month and I am paying out 10k in salaries (including mine) and generating about 15k in revenue from regular therapy and testing clients. I would like to get more passive revenue stream down the road, but right now I’m doing the bulk of the work. My goal is to train up the interns and then they can take on more of my role as primary therapist for the intensive outpatients and I can focus on overseeing things and adding additional clinical support.

 

[Fan_of_Meehl]

As a private practice owner, I have hired on 3 new contractors with a possible 4th in the pipeline. With this in mind, I have to consider more innovative and mutually beneficial methods to earn more passive income while also balancing the fact of keeping my contractors to ensure they feel respected, have a sense of agency, have autonomy, and importantly, earn higher salaries than what they might get working for an organization such as the VA or an AMC.

Thus far, the current strategy has been to pay my contractor 75% of their earnings, and I keep 25%. I have recently modified my contract and advertisement so that any new folks I bring on board will keep 70% and I keep 30%. For example, if I have my contractors see 25 patients a week. with the patient being charged $124 per session, then they are keeping $93 of that billable. Rather than keep a stagnant rate, I had a thought of having a tiered system such as the following:

If contractor sees 1-20 patients a week, they keep 70%, if they see 21-25 patients a week, they keep 75%, if they see 26+ patients a week, the keep 80%. The reason behind this proposal is it helps incentive folks to see more people throughout the week and also can help stabilize a nice passive stream of income for myself.

If I had 5 contractors each seeing 25 patients a week, and they worked a 40 week work year, I would earn $179,800 in passive income.

Thoughts on this?

The only concern that springs immediately to mind is logistical.

At what regular recurring point do you calculate the 'weekly total' and, therefore, the %ages?

Meaning, are you calculating this week-to-week and then adjusting, on a per-client basis, the %ages?

e.g., I am one of your therapists and I see 18 patient encounters this week (completed sessions, not scheduled sessions?), so my take is 70%

If I see 22 patients the following week, I keep 75% (for those patients?).

Or do you do a monthly average?

Quarterly?

 

[AcronymAllergy]

The only concern that springs immediately to mind is logistical.

At what regular recurring point do you calculate the 'weekly total' and, therefore, the %ages?

Meaning, are you calculating this week-to-week and then adjusting, on a per-client basis, the %ages?

e.g., I am one of your therapists and I see 18 patient encounters this week (completed sessions, not scheduled sessions?), so my take is 70%

If I see 22 patients the following week, I keep 75% (for those patients?).

Or do you do a monthly average?

Quarterly?

Good points/questions. Maybe it'd be easier to base the split on surpassing a billing threshold over a period of time, sort of like some hospitals do for RVUs? That'd probably skew in favor of the providers who take mostly or only private pay, although those providers may also be making you more money.

 

[BuckeyeLove]

Props to you for offering the 75/25 fee split.

 

[Fan_of_Meehl]

Props to you for offering the 75/25 fee split.

Agreed.

 

[PsyDr]

My concerns:

1) That 70% number yields a pay in the $80s/hr. There is a mental barrier to that number.
2) That structure has the potential for someone to be paid below the median for the profession. Admittedly, that would be their fault.

I think that could easily be overcome by:

1) Telling people, at hire, that the expectation is to get to 26+ patients/week. "We expect people to come here, work, and make money. I really really really don't want anyone to be sitting at that 70% rate. Starting out, it's fine. If you want to work part time, and you tell me, that's fine. But it is not okay for a full time person to sit at 20 patients per week."

2) Offering ECPs a signing bonus, which allows them some space to create their client base.

 

[WisNeuro]

My concerns:

1) That 70% number yields a pay in the $80s/hr. There is a mental barrier to that number.
2) That structure has the potential for someone to be paid below the median for the profession. Admittedly, that would be their fault.

I think that could easily be overcome by:

1) Telling people, at hire, that the expectation is to get to 26+ patients/week. "We expect people to come here, work, and make money. I really really really don't want anyone to be sitting at that 70% rate. Starting out, it's fine. If you want to work part time, and you tell me, that's fine. But it is not okay for a full time person to sit at 20 patients per week."

2) Offering ECPs a signing bonus, which allows them some space to create their client base.

A shocking number of newer folks in the field consider 20-25 billable hours "full-time" these days.

 

[PsyDr]

A shocking number of newer folks in the field consider 20-25 billable hours "full-time" these days.

I've thought a lot about this. I think this is due to:

1) Pure laziness, dressed up with psychological terms like "processing". If an ER physician can go from a GSW case to a fever, there is no real reason why a psychologist cannot go from patient to patient.

2) Some of the terms used to justify slow work are really just phrases to convey:

a. Composing yourself into the cultural expectation for how psychologists are supposed to behave. This clinical "posture" is relatively new (e.g., watch how Skinner behaves, it's not the restrained posture, with the soft voice.).

b. The psychologist is not maintaining proper emotional boundaries, managing countertransference, and managing transference from the patient.

c. The psychologist was taught to write in an academic manner, that is neither useful nor necessary in clinical practice. This complicates a rather simple process, and slows people down.

3) Not using a TON of CPT codes that are available.

a. Phone call cpt codes. Every time you answer the phone, you should be getting paid. Just like an attorney
b. message cpt codes. Every clinical interaction should be paid.
c. record review cpt codes. All work you do for the case should be paid.
d. family conference cpt codes. If the family can sue you for talking to them, you should at least get paid for the liability.

 

[texanpsychdoc]

Some excellent thoughts all around that I will get back to you on in a bit, but I have a meeting with a state senator for Texas RxP this morning, so I need to prepare for that.

 

[Sanman]

A shocking number of newer folks in the field consider 20-25 billable hours "full-time" these days.

My personal opinion on why this happens? 20-25 clients is a reasonable number to be shooting for if you are in full-time cash practice ($200/hr). The reason for this being I have found cash paying clients more demanding (in terms of hours they want to come in, the experience, etc) and more difficult to find. Now, insurance is a different ballgame with a different level of service. People conflate the two business models. The former is netting you roughly double the latter.

 

[summerbabe]

I've thought a lot about this. I think this is due to:

1) Pure laziness, dressed up with psychological terms like "processing". If an ER physician can go from a GSW case to a fever, there is no real reason why a psychologist cannot go from patient to patient.

2) Some of the terms used to justify slow work are really just phrases to convey:

a. Composing yourself into the cultural expectation for how psychologists are supposed to behave. This clinical "posture" is relatively new (e.g., watch how Skinner behaves, it's not the restrained posture, with the soft voice.).

b. The psychologist is not maintaining proper emotional boundaries, managing countertransference, and managing transference from the patient.

Off topic from the original post but one relevant factor is the type of therapy you provide, which doesn’t usually equate to your compensation (like an ER doc making more than a PCP and the trauma surgeon making more than the ER doc).

If your whole caseload is full of ‘worried wells’, phase of life, and folks who need some brief coping skills coaching, your capacity should be higher and working less is a personal choice or poor processes.

But if you enjoy and specialize in things like trauma, you quickly realize the limits of setting boundaries and actively managing transference of the emotional toll that 4-6 hours, day in day out focused on childhood rapes and deaths and how bleak the world feels to your patient.

I’m still early career but I’ve been on both side of this intensity and the difference was huge for me (e.g., day full of prolonged exposure versus CBT for insomnia).

But in many cases, the therapist serving the patients who can most benefit from talk therapy and requires more effort is probably not seeing a major difference in their income (and potentially making less if they feel like they have to be lower volume in PP) while also experiencing higher burnout.

 

[borne_before]

Okay. First of all, I think the 70/30 and 75/25 are good starting points AND I love the idea of a tiered system.

But, I do not know if 5% incrementals are particularly motivating AND I think you could attract more sturdy workhorses with a slightly more aggressive tiered schedule. I wonder if our homies from econ have any insight, but this is something you might offer, because it has more aggressive tiering. So let's say you bill 100 dollars per session (for math) and the goal is to make 200k in passive.

So start like this:
Tier one: hours 1 to 10 get billed at 60/40 (400 passive per contractor)
Tier two: hours 11 to 20 get billed at 70/30 (300 passive per contractor)
Tier three: 21 to 30 get billed at 80/20 (200 passive per contractor)
Tier four: 30+ is 100/0. Contractor gets all of it.

My logic for the tier four: it will incentivize ppl to get to 30+ each week. It also signals to contractors that you are chill and not super greedy.

This would massively incentivize people getting to 30 each week, I think. By that time you have $700 per week. Times 5 employees that $3500 per week. Times that by 48 weeks is 168k. Now let's boost that number by 25% to get us closer to that $124 rate above and guess where you end up... 210k

In the above scenario the employee would take home 600+700+800+500 = each week if they saw 35 pts (a bonus patient a day really). That's $2600 x 48 =124000 x 25% to correct gets them 156k a year, then taxes and **** would have them cleak 90k at the least.

 

[Sanman]

Off topic from the original post but one relevant factor is the type of therapy you provide, which doesn’t usually equate to your compensation (like an ER doc making more than a PCP and the trauma surgeon making more than the ER doc).

If your whole caseload is full of ‘worried wells’, phase of life, and folks who need some brief coping skills coaching, your capacity should be higher and working less is a personal choice or poor processes.

But if you enjoy and specialize in things like trauma, you quickly realize the limits of setting boundaries and actively managing transference of the emotional toll that 4-6 hours, day in day out focused on childhood rapes and deaths and how bleak the world feels to your patient.

I’m still early career but I’ve been on both side of this intensity and the difference was huge for me (e.g., day full of prolonged exposure versus CBT for insomnia).

But in many cases, the therapist serving the patients who can most benefit from talk therapy and requires more effort is probably not seeing a major difference in their income (and potentially making less if they feel like they have to be lower volume in PP) while also experiencing higher burnout.

Though this can be improved somewhat through experience (and acceptance) the other issue in PP is that someone with severe trauma or SMI is less likely to be making good money or have great health insurance. So, in PP, the less severe cases are usually the best paying. My most severe cases were usually Medicaid (which ends up being a double insult as you get paid crumbs for all your work).

 

[PsyDr]

Off topic from the original post but one relevant factor is the type of therapy you provide, which doesn’t usually equate to your compensation (like an ER doc making more than a PCP and the trauma surgeon making more than the ER doc).

If your whole caseload is full of ‘worried wells’, phase of life, and folks who need some brief coping skills coaching, your capacity should be higher and working less is a personal choice or poor processes.

But if you enjoy and specialize in things like trauma, you quickly realize the limits of setting boundaries and actively managing transference of the emotional toll that 4-6 hours, day in day out focused on childhood rapes and deaths and how bleak the world feels to your patient.

I’m still early career but I’ve been on both side of this intensity and the difference was huge for me (e.g., day full of prolonged exposure versus CBT for insomnia).

But in many cases, the therapist serving the patients who can most benefit from talk therapy and requires more effort is probably not seeing a major difference in their income (and potentially making less if they feel like they have to be lower volume in PP) while also experiencing higher burnout.

1) I was pointing out that ER physicians see some horrific stuff, and get back to work.

2) Regardless of feelings, 4 hour work days are not a viable business model. It's just not.

 

[PsychPhDone]

1) I was pointing out that ER physicians see some horrific stuff, and get back to work.

2) Regardless of feelings, 4 hour work days are not a viable business model. It's just not.

Have you seen the EM forum? They are burnt out. Just because you can doesn't mean you should.

 

[foreverbull]

My personal opinion on why this happens? 20-25 clients is a reasonable number to be shooting for if you are in full-time cash practice ($200/hr). The reason for this being I have found cash paying clients more demanding (in terms of hours they want to come in, the experience, etc) and more difficult to find. Now, insurance is a different ballgame with a different level of service. People conflate the two business models. The former is netting you roughly double the latter.

I agree. I would also add that anyone could potentially see 30+ private practice clients per week for therapy, but there will be a marked difference in quality between me personally seeing a lower number vs a higher number. I provide quality over quantity, which is part of the exclusivity of running a cash-only practice. I put thought and energy into the clients I have, such as providing resources and referrals, etc. Those are done outside of session. Some I charge for now, like writing letters, but some of it is also just scheduling, payment issues that I have to take care of directly without a biller/admin, etc.

Also keeping in mind that many clients can only afford 2x/month therapy when paying cash in my area, that’s a heckuva lot of clients to keep track of to fill those 30+ hours. In my case, it’d be 50-60, most likely.

If your belief is that the client gets only that hour with you and no thought whatsoever or resources at any other time or any thought to complicated diagnosis, etc., then you could see a lot of clients in PP. I would just argue that they’re probably not getting the best work out of you, and clients may notice.

For example, we have a psychologist who, when our local org has listserv posts for referrals for specific diagnoses and issues, he always immediately responds and says he’s open to taking them, regardless of the issue/concern/diagnosis, most likely to keep his schedule full and income up. But it’s a running joke to my colleague and I (“guess who offered to work with someone with x issue?”) because he says he’s open to taking clients with eating disorders, ADHD, trauma, domestic violence victims, end of life issues/terminal illness, chronic pain…everything. It’s clear he is a jack of all trades and master of none. He is not someone I would ever refer to, but he’s clearly trying to keep his practice full.

 

[smalltownpsych]

I am at 20 sessions a week and am quite busy. Also running a business. 😁 As a practitioner with enough support so that almost all I did was billable in an insurance based practice, I was seeing 30 plus every week and making 150k plus about 30k worth of benefits. Definitely had some tough patients too. High intensity practice should pay a premium just like a tough ER job should. Reality is that some people work hard and get paid less. It’s really up to the individual practitioner to figure out their worth and their skills and preferences and make their choices.

 

[SomeGreatNotion]

Agree with others about the logistics of the tier system (especially with 5% increase not being that enticing). I would reduce the tiers and simplify it if that's the direction you want to go. Otherwise, have you considered an annual merit bonus: e.g.: % of everything over 1100 client hours billed? This limits the logistical work you would need to do to once a year.

 

[Sanman]

I agree. I would also add that anyone could potentially see 30+ private practice clients per week for therapy, but there will be a marked difference in quality between me personally seeing a lower number vs a higher number. I provide quality over quantity, which is part of the exclusivity of running a cash-only practice. I put thought and energy into the clients I have, such as providing resources and referrals, etc. Those are done outside of session. Some I charge for now, like writing letters, but some of it is also just scheduling, payment issues that I have to take care of directly without a biller/admin, etc.

Also keeping in mind that many clients can only afford 2x/month therapy when paying cash in my area, that’s a heckuva lot of clients to keep track of to fill those 30+ hours. In my case, it’d be 50-60, most likely.

If your belief is that the client gets only that hour with you and no thought whatsoever or resources at any other time or any thought to complicated diagnosis, etc., then you could see a lot of clients in PP. I would just argue that they’re probably not getting the best work out of you, and clients may notice.

For example, we have a psychologist who, when our local org has listserv posts for referrals for specific diagnoses and issues, he always immediately responds and says he’s open to taking them, regardless of the issue/concern/diagnosis, most likely to keep his schedule full and income up. But he’s a running joke to my colleague and I because he says he’s open to taking clients with eating disorders, ADHD, trauma, domestic violence victims, end of life issues/terminal illness, chronic pain…everything. It’s clear he is a jack of all trades and master of none. He is not someone I would ever refer to, but he’s clearly trying to keep his practice full.

While I agree with some of what you have said, I disagree with this last piece. I have seen high volume and low volume. This person just sounds desperate and bad at business. The key to seeing high volume with decent patient satisfaction is opposite of this. When I saw high volume, you skipped headaches as much as possible and you limit yourself to popular easy stuff. I had 3-4 canned interventions for the popular stuff I saw, and it was prepped ahead of time. Add in a few supportive cases and you can crank out 40+ patients/wk. I preferred to limit my tough/headache cases to 1-3/day.

 

[smalltownpsych]

Agree with others about the logistics of the tier system (especially with 5% increase not being that enticing). I would reduce the tiers and simplify it if that's the direction you want to go. Otherwise, have you considered an annual merit bonus: e.g.: % of everything over 1100 client hours billed? This limits the logistical work you would need to do to once a year.

I was thinking of a bonus system too. Chunks of money are always more noticeable than small increments. On the other hand, I’m thinking why complicate things at all and just have a straight up tiered system and expect people to work. In other words, if they don’t already have a good work ethic, will this really help, or will it just add to frustrations, make it a good deal for people that work hard and then kick people off the island if they don’t produce.

 

[Sanman]

I am at 20 sessions a week and am quite busy. Also running a business. 😁 As a practitioner with enough support so that almost all I did was billable in an insurance based practice, I was seeing 30 plus every week and making 150k plus about 30k worth of benefits. Definitely had some tough patients too. High intensity practice should pay a premium just like a tough ER job should. Reality is that some people work hard and get paid less. It’s really up to the individual practitioner to figure out their worth and their skills and preferences and make their choices.

I agree, but CMS and health insurers do not. This is how physicians are reimbursed, but not us.

 

[texanpsychdoc]

Sounds like a fairly good strategy. With some of this stuff you just have to roll it out and see if it works and then tailor it as you go. A good business leader doesn’t overthink before trying out new strategies and then is flexible enough to adjust as they implement, but is also cautious to not bend at every employee or contractors whim. Good luck!

My strategy is completely different. I just got another intensive outpatient type patient that I am going to bill 3200 a month for wrap around services and I use 25 an hour interns to help me out with these patients. That would bring the total monthly revenue from that aspect of my business to about 14k a month and I am paying out 10k in salaries (including mine) and generating about 15k in revenue from regular therapy and testing clients. I would like to get more passive revenue stream down the road, but right now I’m doing the bulk of the work. My goal is to train up the interns and then they can take on more of my role as primary therapist for the intensive outpatients and I can focus on overseeing things and adding additional clinical support.

Teach me your ways...how the heck could I set up an IOP? It's funny because I am in an IOP program for SUD at the VA.

The only concern that springs immediately to mind is logistical.

At what regular recurring point do you calculate the 'weekly total' and, therefore, the %ages?

Meaning, are you calculating this week-to-week and then adjusting, on a per-client basis, the %ages?

e.g., I am one of your therapists and I see 18 patient encounters this week (completed sessions, not scheduled sessions?), so my take is 70%

If I see 22 patients the following week, I keep 75% (for those patients?).

Or do you do a monthly average?

Quarterly?

For me, I was thinking I'd look at the clients each provider saw each week, then go in and calculate the percentage based on those tiers. I would calculate the % that corresponds to each tier, then take my cut and pay the contractor. Maybe that is a bit tedious.

Good points/questions. Maybe it'd be easier to base the split on surpassing a billing threshold over a period of time, sort of like some hospitals do for RVUs? That'd probably skew in favor of the providers who take mostly or only private pay, although those providers may also be making you more money.

Good idea - what would be a good a good number to gauge this threshold, and then what % would you apply?

Props to you for offering the 75/25 fee split.

Yeah...I actually recently changed it to 70/30, but the 3 I brought on I am honoring per their contract that I will only take 25%. In the future, I may propose a new contract to adjust it to 70/30, or based on this new scale.

My concerns:

1) That 70% number yields a pay in the $80s/hr. There is a mental barrier to that number.
2) That structure has the potential for someone to be paid below the median for the profession. Admittedly, that would be their fault.

I think that could easily be overcome by:

1) Telling people, at hire, that the expectation is to get to 26+ patients/week. "We expect people to come here, work, and make money. I really really really don't want anyone to be sitting at that 70% rate. Starting out, it's fine. If you want to work part time, and you tell me, that's fine. But it is not okay for a full time person to sit at 20 patients per week."

2) Offering ECPs a signing bonus, which allows them some space to create their client base.

I mean, my hourly with the VA is $45.81. I get it, most people will want to earn $90-100 minimum, but honestly, if this is a side gig for them, then that's how it should be framed, and that comes from doing good "informed consent" with them that if they want more, they have to work more. Alternatively, this new pay scale could alleviate this and incentive them to work more because they will earn more, so, if they don't want $80ish an hour, it's to their advantage to see 25+ a week...they earn more. I offer fringe benefits such as $500 annually to pay for CEUs, paid listings on Psychology Today and Mental Health Match, and I get them credentialed with insurances (I do that myself). All they have to do is see patients, collect their co-pay, and re-schedule them, that's it.

I've thought a lot about this. I think this is due to:

1) Pure laziness, dressed up with psychological terms like "processing". If an ER physician can go from a GSW case to a fever, there is no real reason why a psychologist cannot go from patient to patient.

2) Some of the terms used to justify slow work are really just phrases to convey:

a. Composing yourself into the cultural expectation for how psychologists are supposed to behave. This clinical "posture" is relatively new (e.g., watch how Skinner behaves, it's not the restrained posture, with the soft voice.).

b. The psychologist is not maintaining proper emotional boundaries, managing countertransference, and managing transference from the patient.

c. The psychologist was taught to write in an academic manner, that is neither useful nor necessary in clinical practice. This complicates a rather simple process, and slows people down.

3) Not using a TON of CPT codes that are available.

a. Phone call cpt codes. Every time you answer the phone, you should be getting paid. Just like an attorney
b. message cpt codes. Every clinical interaction should be paid.
c. record review cpt codes. All work you do for the case should be paid.
d. family conference cpt codes. If the family can sue you for talking to them, you should at least get paid for the liability.

I am really curious how people are getting paid for phone calls when they are an insurance-based client. Imagine a client of mine calling me randomly at 2:15PM..."hey Bob, before we talk, can I charge your card real quick for that co-pay for this phone call so I can bill your insurance?"

 

[texanpsychdoc]

Okay. First of all, I think the 70/30 and 75/25 are good starting points AND I love the idea of a tiered system.

But, I do not know if 5% incrementals are particularly motivating AND I think you could attract more sturdy workhorses with a slightly more aggressive tiered schedule. I wonder if our homies from econ have any insight, but this is something you might offer, because it has more aggressive tiering. So let's say you bill 100 dollars per session (for math) and the goal is to make 200k in passive.

So start like this:
Tier one: hours 1 to 10 get billed at 60/40 (400 passive per contractor)
Tier two: hours 11 to 20 get billed at 70/30 (300 passive per contractor)
Tier three: 21 to 30 get billed at 80/20 (200 passive per contractor)
Tier four: 30+ is 100/0. Contractor gets all of it.

My logic for the tier four: it will incentivize ppl to get to 30+ each week. It also signals to contractors that you are chill and not super greedy.

This would massively incentivize people getting to 30 each week, I think. By that time you have $700 per week. Times 5 employees that $3500 per week. Times that by 48 weeks is 168k. Now let's boost that number by 25% to get us closer to that $124 rate above and guess where you end up... 210k

In the above scenario the employee would take home 600+700+800+500 = each week if they saw 35 pts (a bonus patient a day really). That's $2600 x 48 =124000 x 25% to correct gets them 156k a year, then taxes and **** would have them cleak 90k at the least.

I'm loving this idea. This seems more straight forward and sellable. This will likely work well for my contractors who only see therapy clients, alternatively, I will need to figure out a comparable solution for my assessment folks.

 

[PsyDr]

I am really curious how people are getting paid for phone calls when they are an insurance-based client. Imagine a client of mine calling me randomly at 2:15PM..."hey Bob, before we talk, can I charge your card real quick for that co-pay for this phone call so I can bill your insurance?"

1) Please allow me to introduce you to:
a. The google search term "audio only"
b. His buddies from the CPT code: 98966 ,98967, and 98968.

2) If you're not billing for your professional services over the phone, what services do you regularly offer for free?

3) I always viewed payment as a way to invest. Well paid people won't want to leave, and won't become competition. I want them to feel like my offer is too good to let go. And if they leave, I want them to talk about me in good terms.

 

[texanpsychdoc]

1) Please allow me to introduce you to:
a. The google search term "audio only"
b. His buddies from the CPT code: 98966 ,98967, and 98968.

2) If you're not billing for your professional services over the phone, what services do you regularly offer for free?

3) I always viewed payment as a way to invest. Well paid people won't want to leave, and won't become competition. I want them to feel like my offer is too good to let go. And if they leave, I want them to talk about me in good terms.

So, if I have a client that reaches out to me between sessions and it runs over 15min., I would charge them a co-pay then bill? I technically have this verbiage in my informed consent, but I have never applied it/not really had too many instances where this needed to happen.

The only "free" thing I offer are the initial 15 minute phone consultations to see if it's a good fit.

 

[Sanman]

So, if I have a client that reaches out to me between sessions and it runs over 15min., I would charge them a co-pay then bill? I technically have this verbiage in my informed consent, but I have never applied it/not really had too many instances where this needed to happen.

The only "free" thing I offer are the initial 15 minute phone consultations to see if it's a good fit.

Depends how often you see them.

 

[PsyDr]

So, if I have a client that reaches out to me between sessions and it runs over 15min., I would charge them a co-pay then bill? I technically have this verbiage in my informed consent, but I have never applied it/not really had too many instances where this needed to happen.

The only "free" thing I offer are the initial 15 minute phone consultations to see if it's a good fit.

For patients, you inform them that you charge for every service, including calls, at intake. Some practices have a credit card agreement for auto-billing of co-pays. Once they are established:

If they call you for 5-10 minutes, you bill 98966. If it's 11-20 minutes you bill 98967. If it's 21-30 minutes you bill 98968.

 

[WisNeuro]

I don't do many patient phone calls aside from scheduling, as that's the smaller part of my practice. But I sure as hell bill my 15 minute increments anytime I talk to a lawyer on an IME case.

 

[quickpsych]

I think the fee split is a good split. I briefly did some work with a psychologist and her split was similar with increases in percentage of split based on number of hours billed each 2 weeks (it was mostly assessments). She also offered a 3% match on a Simple IRA, $400 a year towards CEs, and ran everything through payroll which meant no self employment taxes. I only left because I got offered a job that paid more and was more in line with what I wanted to do at the time. But if I ever started a small group practice, I'd follow her example.

As for the 20-25 patients a week caseload being "too low" and "not full time." I think it depends on a few factors. If you work in a setting where brief sessions or brief evaluations (i.e. 16-30 minutes) are the norm such as in some health care settings, then yeah 20-25 patients/services a week is not full time. But if you're doing full 45-55 minute recurring sessions , I would not work for a group practice or company that demands productivity of more than 25 a week. I know someone who works at a well known and well respected large group practice and were excited they make $92k a year with benefits. But their productivity expectation is 37 billable patient sessions a week. They could do much better on their own or in a practice that even pays them just $100 per session at less than 37 a week and still more if they made more per hour and saw 20 patients a week. I did my time pre-licensed in community mental health where you'd be lucky to get a lunch break if they thought they could get away with filling 40 hours of a 40 hour work week. No thanks to doing that again when I can work 4-5 hours a day a few days a week and do alright (and that's before considering if/when I do a small telehealth practice on the side).

 

[PikminOC]

My personal opinion on why this happens? 20-25 clients is a reasonable number to be shooting for if you are in full-time cash practice ($200/hr). The reason for this being I have found cash paying clients more demanding (in terms of hours they want to come in, the experience, etc) and more difficult to find. Now, insurance is a different ballgame with a different level of service. People conflate the two business models. The former is netting you roughly double the latter.

Is op referring to a cash practice? And all patients are demanding

 

[PsyDr]

Have you seen the EM forum? They are burnt out. Just because you can doesn't mean you should.

1) Name any profession that works 4 hours a day. It doesn’t exist.

2) just because some people can’t handle the job, and skew the mean, doesn’t mean everyone else should have to get lower salaries.

 

[texanpsychdoc]

Is op referring to a cash practice? And all patients are demanding

No....I take insurance and cash patients. Some of my contractors will only be cash, while some will take both as I do.

 

[texanpsychdoc]

1) Name any profession that works 4 hours a day. It doesn’t exist.

2) just because some people can’t handle the job, and skew the mean, doesn’t mean everyone else should have to get lower salaries.

Indeed - the reality is, as much as I put into marketing my practice for prospective patients, I am doing the same with finding new contractors who will demonstrate certain qualities and work ethic I am in need of. The folks who are looking to take on 5-10 patients a week and work whenever they want are not going to be in my candidate pool. Granted, when I first started hiring, that was a sentiment I expressed and will abide by with the 3 that I hired on, however, going forward, I have made changes so that I attract and retain contractors who are at a minimum able to see 14 patients a week. The whole point in my tiered system is to incentivize rather than require or force people to see 25+ a week, but, a bar must be set and I think if a minimum were to be set, then 14 a week is feasible. I remember I was a contractor with this forensic practice doing remote evals and they required a minimum of 8 evals a week (the pay was crap for the time and effort spent doing the evals and writing it up - I was literally able to make more seeing 4 insurance therapy patients a week; it wasn't worth my time).

 

[summerbabe]

1) Name any profession that works 4 hours a day. It doesn’t exist.

2) just because some people can’t handle the job, and skew the mean, doesn’t mean everyone else should have to get lower salaries.

1, If somebody can just 'work' 4 hours a day and satisfy their income needs, more power to them. And isn't that exactly the flexibility that PP proposes? And while the standard job revolves around the 8/10 hour shift, plenty of specific jobs in every industry are poorly optimized (e.g., stretching out 2 hours of genuine work over an 8 hour day, taking work home with you even if you are working at max efficiency).

Adding onto the point about ER docs moving from one trauma to another - just because they can do it doesn't mean it's a good model. It's also probably not a great societal sign that physicians experience significant signs of depression and consider/complete suicide at significantly higher rates than the general population and that certain higher intensity specialties appear especially impacted.

2. There are plenty of institutions already skewing salaries like community mental health, state psychiatric facilities, and college counseling centers that I don't think lower volume PP folks are making a large dent. Or it might even out if some of these people are also charging and securing a higher hourly rate.

I am doing the same with finding new contractors who will demonstrate certain qualities and work ethic I am in need of. The folks who are looking to take on 5-10 patients a week and work whenever they want are not going to be in my candidate pool. Granted, when I first started hiring, that was a sentiment I expressed and will abide by with the 3 that I hired on, however, going forward, I have made changes so that I attract and retain contractors who are at a minimum able to see 14 patients a week. The whole point in my tiered system is to incentivize rather than require or force people to see 25+ a week, but, a bar must be set and I think if a minimum were to be set, then 14 a week is feasible.

Some random thoughts regarding retention/incentivization, albeit from somebody who has never done PP:

If the goal is to secure/retain people with a matching work ethic, I wonder if that's compatible with dropping the 75/25 split to 70/30 while adding the incentive bonus that one may or may not hit (including due to factors like no-shows and cancellations that they can't control).

Offering a higher split theoretically widens your search pool and keeps people happy (e.g., if they know others in PP who get a worse split, if they go on the job market casually and learns that your split/perks is the same or better than what's out there) and offering incentives is a morale boost, especially since each contractor can go start their own individual or group PP at any given moment.

If a contractor leaves, you'll have to endure a period where you lose their income stream (which will be more relevant once you transition out of the VA) plus you'll need to spend extra time recruiting/interviewing/onboarding. And if they are not a good fit, that will have its own headaches.

So basically - what's the value of the additional 5% that you'd pocket minus economic losses if a high performer quits? They may obviously have other compelling reasons beyond the split/incentive structure, including non-economic ones.

Especially for the long-term retention of your cash only contractors, what is their incentive to remain steady with you since they are bypassing your legwork for insurance paneling and nobody needs office space for a telehealth only practice? What % of their caseload will come from your marketing/referral efforts versus their own? If they are also securing a large portion of their patients for a telehealth only practice, it seems like it would be in their best economic interests to move on sooner than later.

 

[texanpsychdoc]

1, If somebody can just 'work' 4 hours a day and satisfy their income needs, more power to them. And isn't that exactly the flexibility that PP proposes? And while the standard job revolves around the 8/10 hour shift, plenty of specific jobs in every industry are poorly optimized (e.g., stretching out 2 hours of genuine work over an 8 hour day, taking work home with you even if you are working at max efficiency).

Adding onto the point about ER docs moving from one trauma to another - just because they can do it doesn't mean it's a good model. It's also probably not a great societal sign that physicians experience significant signs of depression and consider/complete suicide at significantly higher rates than the general population and that certain higher intensity specialties appear especially impacted.

2. There are plenty of institutions already skewing salaries like community mental health, state psychiatric facilities, and college counseling centers that I don't think lower volume PP folks are making a large dent. Or it might even out if some of these people are also charging and securing a higher hourly rate.

Some random thoughts regarding retention/incentivization, albeit from somebody who has never done PP:

If the goal is to secure/retain people with a matching work ethic, I wonder if that's compatible with dropping the 75/25 split to 70/30 while adding the incentive bonus that one may or may not hit (including due to factors like no-shows and cancellations that they can't control).

Offering a higher split theoretically widens your search pool and keeps people happy (e.g., if they know others in PP who get a worse split, if they go on the job market casually and learns that your split/perks is the same or better than what's out there) and offering incentives is a morale boost, especially since each contractor can go start their own individual or group PP at any given moment.

If a contractor leaves, you'll have to endure a period where you lose their income stream (which will be more relevant once you transition out of the VA) plus you'll need to spend extra time recruiting/interviewing/onboarding. And if they are not a good fit, that will have its own headaches.

So basically - what's the value of the additional 5% that you'd pocket minus economic losses if a high performer quits? They may obviously have other compelling reasons beyond the split/incentive structure, including non-economic ones.

Especially for the long-term retention of your cash only contractors, what is their incentive to remain steady with you since they are bypassing your legwork for insurance paneling and nobody needs office space for a telehealth only practice? What % of their caseload will come from your marketing/referral efforts versus their own? If they are also securing a large portion of their patients for a telehealth only practice, it seems like it would be in their best economic interests to move on sooner than later.

So, I do offer a referral bonus to my contractors if they bring someone on since I am paying for them to market themselves, however, if by chance they secure a new client outside of the direct marketing efforts I pay for them (i.e., paying for them to be listed in directories), they are still getting that bonus. Folks are free to leave to start their own practice (I don't have a non-compete clause), but typically, I have found majority of psychologists will prefer to work for others while a minority will want to start their own business (the VA is a great example of this being the case). I think the tiered system the borne_before mentioned since it actually really incentivizes people to see more folks because the retain more of their earnings.

For example, if a contractor saw a client at the rate of $124 for a 50 minute session, this is what they could expect to earn based on whether they see 25 vs. 30 patients a week for a 48 week work year:

Weekly

1-10 (60%) = $744


11-20 (70%) = $868


21-25 (80%) = $496


26-30 (100%) = $620


Total = $2108 (25)/ $2728 (30)


Annually (48 weeks):

$101,184 (25)/ $130,944 (30)

These figures don't account for the new initial evaluations which will be slightly higher in pay, whether or not they take on testing cases, groups, or couples work which will net them more in my practice. In the end, I am running a business, not a charity, so, if someone believes they are better off starting their own business, I applaud them and encourage that, but I am betting they won't due to the trend amongst psychologists I mentioned earlier. Heck, I have a contractor I am good friends with who agreed to join my practice so long the I could help them get their private practice going, so I am willing to help them to start from the ground up, but even in their beginning phases of doing this, they expressed immense ambivalence, uncertainty, and apprehension in doing this as they were unsure of how to go about setting up an LLC, business banking, marketing, and all sorts of other components associated with running a business (i.e., crafting practice policies, scheduling policies, etc.) and then integrating the clinical aspect to that business (i.e., crafting informed consent, note and report templates). Companies like Lifestance, Alma, Sondermind are jumping at the fact that most mental health providers will prefer to "plug and play" vs. start up their own business. Unfortunately, many of those hedge-fund backed "group" corporate practices take a large chunk of the contractor's money amongst other drawbacks. That is not what my practice is about.

Right now, if a psychologist wanted to just work for the VA as a GS-12 in my area, they'd earn $45.81 an hour, work 8 hours, see about 30 patients a week amongst the heavier administrative BS burdens the VA loves to throw at people...not to mention the veteran population that just kills it for me with the sense of entitlement and other BS. The folks I have had inquiries from to work for me, all have mentioned that what they see advertised was highly appealing and leaps and bounds better than other offers they've seen or entertained. So that tells me, I am in the ballpark. I can't please everybody, nor can I be "everything to everybody," so, there will always be some folks that won't be satisfied, and honestly, I'd likely not want them in my practice if that's the case.

In the end, a big reason I will hire contractors for now rather than permanent employees is that contractors have a minimal impact on my business's expenditures. I need lower costs. Contractors allow me a lot of flexibility to be agile when I need to be. I am not looking to be heartless, but again, Im in the business to make money and help people, not to be Noah's Arc.

My favorite question I have seen from others is "why can't they just cut you out of the middle and start their own?".....indeed...why not? Go do it. I encourage it. But that person elects not to, then these are the parameters I set, which is more than fair and equitable, and if they don't like it....bye Felicia.

 

[PsyDr]

1, If somebody can just 'work' 4 hours a day and satisfy their income needs, more power to them. And isn't that exactly the flexibility that PP proposes? And while the standard job revolves around the 8/10 hour shift, plenty of specific jobs in every industry are poorly optimized (e.g., stretching out 2 hours of genuine work over an 8 hour day, taking work home with you even if you are working at max efficiency).

Adding onto the point about ER docs moving from one trauma to another - just because they can do it doesn't mean it's a good model. It's also probably not a great societal sign that physicians experience significant signs of depression and consider/complete suicide at significantly higher rates than the general population and that certain higher intensity specialties appear especially impacted.

2. There are plenty of institutions already skewing salaries like community mental health, state psychiatric facilities, and college counseling centers that I don't think lower volume PP folks are making a large dent. Or it might even out if some of these people are also charging and securing a higher hourly rate.

1) I guess that is the difference between what the neuroscience literature calls utilitarianism emotional intuition. And the idea of the purpose of a profession (i.e., making money vs helping people). Piaget wrote a lot about this, before the neuroscience people came around.

2) Psychologists have rates of SI of approximately 29% (e.g., Pope & Tabachnick, 1994; Gilroy et al, 2002; APA, 2010; etc). Not sure why a study that shows 7.2% of ER physicians suffer from SI would be pertinent. Especially when lower income is a risk factor for the expression of SI.

 

[PikminOC]

So, I do offer a referral bonus to my contractors if they bring someone on since I am paying for them to market themselves, however, if by chance they secure a new client outside of the direct marketing efforts I pay for them (i.e., paying for them to be listed in directories), they are still getting that bonus. Folks are free to leave to start their own practice (I don't have a non-compete clause), but typically, I have found majority of psychologists will prefer to work for others while a minority will want to start their own business (the VA is a great example of this being the case). I think the tiered system the borne_before mentioned since it actually really incentivizes people to see more folks because the retain more of their earnings.

For example, if a contractor saw a client at the rate of $124 for a 50 minute session, this is what they could expect to earn based on whether they see 25 vs. 30 patients a week for a 48 week work year:

Weekly

1-10 (60%) = $744


11-20 (70%) = $868


21-25 (80%) = $496


26-30 (100%) = $620


Total = $2108 (25)/ $2728 (30)


Annually (48 weeks):

$101,184 (25)/ $130,944 (30)

These figures don't account for the new initial evaluations which will be slightly higher in pay, whether or not they take on testing cases, groups, or couples work which will net them more in my practice. In the end, I am running a business, not a charity, so, if someone believes they are better off starting their own business, I applaud them and encourage that, but I am betting they won't due to the trend amongst psychologists I mentioned earlier. Heck, I have a contractor I am good friends with who agreed to join my practice so long the I could help them get their private practice going, so I am willing to help them to start from the ground up, but even in their beginning phases of doing this, they expressed immense ambivalence, uncertainty, and apprehension in doing this as they were unsure of how to go about setting up an LLC, business banking, marketing, and all sorts of other components associated with running a business (i.e., crafting practice policies, scheduling policies, etc.) and then integrating the clinical aspect to that business (i.e., crafting informed consent, note and report templates). Companies like Lifestance, Alma, Sondermind are jumping at the fact that most mental health providers will prefer to "plug and play" vs. start up their own business. Unfortunately, many of those hedge-fund backed "group" corporate practices take a large chunk of the contractor's money amongst other drawbacks. That is not what my practice is about.

Right now, if a psychologist wanted to just work for the VA as a GS-12 in my area, they'd earn $45.81 an hour, work 8 hours, see about 30 patients a week amongst the heavier administrative BS burdens the VA loves to throw at people...not to mention the veteran population that just kills it for me with the sense of entitlement and other BS. The folks I have had inquiries from to work for me, all have mentioned that what they see advertised was highly appealing and leaps and bounds better than other offers they've seen or entertained. So that tells me, I am in the ballpark. I can't please everybody, nor can I be "everything to everybody," so, there will always be some folks that won't be satisfied, and honestly, I'd likely not want them in my practice if that's the case.

In the end, a big reason I will hire contractors for now rather than permanent employees is that contractors have a minimal impact on my business's expenditures. I need lower costs. Contractors allow me a lot of flexibility to be agile when I need to be. I am not looking to be heartless, but again, Im in the business to make money and help people, not to be Noah's Arc.

My favorite question I have seen from others is "why can't they just cut you out of the middle and start their own?".....indeed...why not? Go do it. I encourage it. But that person elects not to, then these are the parameters I set, which is more than fair and equitable, and if they don't like it....bye Felicia.

The contractors will have to also pay 7.5 percent of their own for payroll tax if you are making them a 1099

 

[smalltownpsych]

Teach me your ways...how the heck could I set up an IOP? It's funny because I am in an IOP program for SUD at the VA.



For me, I was thinking I'd look at the clients each provider saw each week, then go in and calculate the percentage based on those tiers. I would calculate the % that corresponds to each tier, then take my cut and pay the contractor. Maybe that is a bit tedious.



Good idea - what would be a good a good number to gauge this threshold, and then what % would you apply?



Yeah...I actually recently changed it to 70/30, but the 3 I brought on I am honoring per their contract that I will only take 25%. In the future, I may propose a new contract to adjust it to 70/30, or based on this new scale.



I mean, my hourly with the VA is $45.81. I get it, most people will want to earn $90-100 minimum, but honestly, if this is a side gig for them, then that's how it should be framed, and that comes from doing good "informed consent" with them that if they want more, they have to work more. Alternatively, this new pay scale could alleviate this and incentive them to work more because they will earn more, so, if they don't want $80ish an hour, it's to their advantage to see 25+ a week...they earn more. I offer fringe benefits such as $500 annually to pay for CEUs, paid listings on Psychology Today and Mental Health Match, and I get them credentialed with insurances (I do that myself). All they have to do is see patients, collect their co-pay, and re-schedule them, that's it.



I am really curious how people are getting paid for phone calls when they are an insurance-based client. Imagine a client of mine calling me randomly at 2:15PM..."hey Bob, before we talk, can I charge your card real quick for that co-pay for this phone call so I can bill your insurance?"

The IOP I am setting up is strictly cash. I have connections to private pay residential programs so I get aftercare referrals. Then I use a counseling intern and a social work intern to provide some clinical support/mentoring. Also can have family sessions or coaching as these are young adults that aren’t completely independent. Interns are getting paid 25 an hour. I just keep adding in things as people need it. One goal is to get another group up and running. Another is to have a drop in/hang out recreation type area. My admin support was also a program manager at a residential program so offers quite a bit to patients too. The main thing is that I have to hire people and then get frustrated because it feels like I am doing the bulk of the work. 😉 Then I have to remember that even though I do a good job and am doing most of the therapy and the oversight, I wouldn’t be able to justify the extra money I’m charging without the payroll. It is. Ore complicated than straight outpatient, but I like the change of pace.

 

[texanpsychdoc]

The contractors will have to also pay 7.5 percent of their own for payroll tax if you are making them a 1099

No one is putting a gun to their head to sign on as a contractor. You can't get perfection. Their finances are frankly not my problem. I have plenty of folks I have hired on board, and I anticipate this trend to continue. Can't win them all.

 

[PikminOC]

No one is putting a gun to their head to sign on as a contractor. You can't get perfection. Their finances are frankly not my problem. I have plenty of folks I have hired on board, and I anticipate this trend to continue. Can't win them all.

How are they contractor's and not employees?

 

[texanpsychdoc]

How are they contractor's and not employees?

Because it's spelled out like that in the contract. An employee is a W-2/W-4 where I'd be responsible for paying off their taxes through their earnings and via payroll. A I-9/W-9/1099 contractor has no standing as an employee - should they do something that rises to the level of malpractice, it is spelled out that my business is not on the hook - the contractor is, and, I require them to identify my company as a covered entity under their malpractice insurance. Also, contractors pay/file their own taxes. Contractors work however much they want - there are no set hours of patients I am having them see that their pay is contingent on.

 

[WisNeuro]

Because it's spelled out like that in the contract. An employee is a W-2/W-4 where I'd be responsible for paying off their taxes through their earnings and via payroll. A I-9/W-9/1099 contractor has no standing as an employee - should they do something that rises to the level of malpractice, it is spelled out that my business is not on the hook - the contractor is, and, I require them to identify my company as a covered entity under their malpractice insurance. Also, contractors pay/file their own taxes. Contractors work however much they want - there are no set hours of patients I am having them see that their pay is contingent on.

did you consult with an employment lawyer about the contract? Setting their own hours is only one of the guidelines that needs to be met to qualify as contractor vs. employee. A good number of practices here made that mistake and paid a lot of state and federal fines for misclassifying their psychologists/therapists in recent years.

 

[WisNeuro]

Better yet, you should file an SS-8 and have documentation in case of an audit down the road, which is not all that rare.

 

[psychma]

I have my MA. 10 years ago, I earned $10/hr as an intern. As a new therapist, I earned $23/hr. I wised up and started my own private pay private practice. I am so busy I had to raise my rates twice. I recently upped them and earn well over $93/hour and I’m completely full. I could never go back to helping someone earn their passive income stream. I wonder if someone with a PhD is willing to accept that.

 

[WisNeuro]

I have my MA. 10 years ago, I earned $10/hr as an intern. As a new therapist, I earned $23/hr. I wised up and started my own private pay private practice. I am so busy I had to raise my rates twice. I recently upped them and earn well over $93/hour and I’m completely full. I could never go back to helping someone earn their passive income stream. I wonder if someone with a PhD is willing to accept that.

People with a wide variety of degrees are willing to accept this quite easily. It's not hard to find therapists to hire in most practices. A little bit harder for specialty providers, but not that difficult.

 

[texanpsychdoc]

Better yet, you should file an SS-8 and have documentation in case of an audit down the road, which is not all that rare.

My practice is fully compliant.

 

[WisNeuro]

My practice is fully compliant.

If you've already done the SS-8, good work, if you haven't, I wouldn't be 100% sure.

 

[PikminOC]

If you've already done the SS-8, good work, if you haven't, I wouldn't be 100% sure.

Yes thank you. That is a big thing I have found with people who hire contractors. They don't know the difference between them and employees

 

[WisNeuro]

Yes thank you. That is a big thing I have found with people who hire contractors. They don't know the difference between them and employees

Yeah, I know too many people that have learned this lesson the hard way. They assumed just because the employee made their own hours and some other small things that they were contractors. They apparently forgot about the other domains of assessing contractor vs. employee status. Whatever the situation, if I was planning on hiring contractors, I would want that response from the IRS re: ss-8 before I did anything.