So do the psychologists do the majority of therapy and the psychiatrists do mostly med management?
Slightly related -- and obviously this will be variable -- what is the average salary that both a PhD/PsyD psychologist & an LPC masters level therapist would command within the outpatient setting? The reason I ask is I like the stratification idea with getting a solid infrastructure of therapists/counselors. But it seems the salary of the psychologist is much higher so I'm curious how much revenue they can bring in?
In theory, you can try to set up a practice like that where you do meds for a bunch of therapists, and take a cut off their revenue. In practice, this is uncommon because psychologists, like psychiatrists, usually prefer a solo/small group situation and are not likely willing to be "purchased" as an employee of an MD-run practice. More commonly, the psychiatrist simply collaborate with external therapists to build up a caseload. Referrals from psychiatrists are usually not a big source of revenue for PhDs and LCSWs, mostly because they are targeting different sectors of the market. Pure cash PhDs/PsyDs are somewhat uncommon, whereas pure cash MD is >50% in private practice.
As an MD, there are several styles of practice you can set up:
1) Institutional (VA, other govt, academic, non-profit): you'll be doing mostly med management, with the occasional therapy. Fixed lower salary (but usually >200k, can be very good depending on location) usually very good benefits. somewhat fixed inflexible schedule but low salary variation, no startup cost (in fact sometimes negative startup cost with signon bonus, moving and loan repayment, etc)
2) Community insurance based small group/solo PP: mostly med management, ++ overhead (biller, secretary, allied providers), high volume, viable throughout the country. Some therapy patients if you want depending on the insurance mix. If busy can be very profitable. no benefits, flexible schedule. lots of quality improvement issues/business operational work, once set up fairly low salary variation, high start-up cost =====> this is not uncommon from what I've heard around APA, etc., especially in the Midwest/low density areas. Some hardworking community psychs can command high salaries doing this. And yes this is where therapy can be farmed out to PhDs and LCSWs within the same practice, but fairly uncommon. What's more common is a single specialty MD group practice that works with a large managed care organization that also coordinates with a PhD group. This is essentially the model for most community PP of other medical specialties (i.e. IM, OB/GYN, peds, etc.). But MCO penetration in psych is much much lower compared to other specialties because of lower overhead.
3) Solo/small group therapy focus, insurance or cash based: viable throughout the country even in less affluent parts of the country. MD who prefers doing a lot of therapy, but is willing to either 1) take a few insurances or 2) charge a lower fee. -- overhead, - volume. Mostly combined med management plus therapy. expected salary is <200k. no benefits. good autonomy and geographical and scheduling flexibility, high salary variation, low start-up cost. This is also fairly common, especially with older psychiatrists, or psychiatrists who want to work part time.
4) Solo/small group high end cash practice: only doable in a few locations, high per session cost (generally >$300), very few patients (usually a full time practice <100 patients, sometimes <50). Majority combined therapy med. Most revenue from therapy. very low overhead, high salary, flexible scheduling, high start-up cost (counting waiting time opportunity cost), but ++ entry barrier, ++ salary variation
5) Others, things like locum, ER work, etc. Some MDs never do anything with continuity.
As you can see, this idea that MDs can't do therapy is mostly a myth perpetuated by institutional players who want to make you take a job doing mostly med management. You have a lot of choice as an MD in terms of what mix of work you can do in PP.
