Scaling a Practice

[texanpsychdoc]

I was curious, how could one add new providers to form a group practice? Having recently become paneled with 3 insurance companies, United advised me that in order for me to apply to them as a group practice, I would need 5 independently paneled providers in my practice to qualify for an application as a group panel. With that being said, my hopes were to bring on new providers so that as referrals come in more frequent and steady (that's the hope), that I can add a new provider to take on those referrals. As it stands now, I am unsure how to go about this. Any thoughts?

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[smalltownpsych]

I am using a different strategy due to a cash practice and an intensive outpatient program so am hiring interns to support my patients who need extra help and have resources to pay for it and also to provide a lower cost therapy option for other patients. When they get licensed, i might help them get paneled with an insurance or two. Depends on how much cash business I can generate. I have been advertising on Indeed and that seems to go pretty well. As far as how to structure it, that really depends on who you are bringing on board. if I was bringing in a psychologist, i would be more likely to give them a split of what they generated and treat them as an independent contractor and potential partner. I think that I would lean towards salaried employee for midlevels. I handle the infrastructure and support and they get a decent salary if they are productive. Crunching the numbers well is essential especially in an insurance based practice, but my aim is really to go high end with level of service and so don’t want to really count the nickels as much as invest in the bigger picture. Good luck! Tell us how it goes.

 

[PsyDr]

You get a clinic NPI, then have your colleagues fill out a reassignment of reimbursement form. Then you pay them according to their contract.

Reminder: Unfair payment arrangement, including 50/50, is unethical and a BAD business plan. It is MUCH smarter to pay 75/25, let them create a panel of patients, make them want to stay because it is cheaper to stay with you than start a competing business, and create long term profits.

 

[BuckeyeLove]

And if you do 50/50 you're a garbage human just my personal opinion.

 

[WisNeuro]

Make sure you are classifying your employees correctly (1099 vs. W2). Several clinics round these parts have been slapped and hit with fines for incorrectly calling some people W2s over the years.

And if you do 50/50 you're a garbage human just my personal opinion.

Places easily get away with this when they have an ample supply of diplom millers. There are two such large clinics almost exclusively staffed with grads from a (now) closed down mill who all on 50/50 contracts.

 

[texanpsychdoc]

All good points and things that I have considered and implemented. I have a contractor agreement that is legally sound. In that agreement I outline a 70/30 split of fees, along with payments that will be issued (2nd week of the following month). My thinking on this is, I could bring on either someone who is already paneled with my insurances, but I would need to figure out why opting to work in my practice is better for them vs. them going out on their own to be a solo practice, or, I can bring a new person on and literally hold their hand through the credentialing process like I did for myself. I did not hire a credentialing company, I applied and successfully paneled with BCBS, Cigna, and United on my own (and awaiting for some others to come through to decide if I will sign with them based on their rates).

Right now my practice is 100% remote, so the idea is that I can offer to get them credentialed, they will not have to worry about attracting clients or any other clerical duty aside from them collecting the appropriate co-pay. I would file the insurance claims along with my own, I would even pay for them to have a Psychology Today profile as a little perk. The'd just login to their sessions and see patients, schedule their own patients, and accept their fees.

Thoughts?

 

[texanpsychdoc]

On a different note - I am getting about 3-4 calls a day on my business phone, which I am hoping are new clients, but they never leave a message. Since my day job with the VA really doesn't allow for me to answer these calls, would you recommend hiring a virtual assistant this early on?

 

[texanpsychdoc]

You get a clinic NPI, then have your colleagues fill out a reassignment of reimbursement form. Then you pay them according to their contract.

Reminder: Unfair payment arrangement, including 50/50, is unethical and a BAD business plan. It is MUCH smarter to pay 75/25, let them create a panel of patients, make them want to stay because it is cheaper to stay with you than start a competing business, and create long term profits.

I do have a NPI type 2, but some companies like United require I have 5 independently paneled providers before I can apply as a group.

 

[PsyDr]

I do have a NPI type 2, but some companies like United require I have 5 independently paneled providers before I can apply as a group.

I understand. You are trying to get the clinic NPI credentialed. That is a high bar that doesn't really benefit you.

The easier way to do this: You hire a psychologist, get them paneled with insurance as an individual provider, and then reassign reimbursement to the clinic NPI. Then you submit their bill to the insurance company, who diverts payment to your clinic account. Out of your clinic account, you pay your employee.

 

[texanpsychdoc]

I understand. You are trying to get the clinic NPI credentialed. That is a high bar that doesn't really benefit you.

The easier way to do this: You hire a psychologist, get them paneled with insurance as an individual provider, and then reassign reimbursement to the clinic NPI. Then you submit their bill to the insurance company, who diverts payment to your clinic account. Out of your clinic account, you pay your employee.

Good point. I think someone I spoke to somewhere else mentioned I could do this as well. I believe in my contractor agreement I mention that they would need to indicate my EIN in their CAQH and in their application to be paneled. I guess my biggest concern is, I go through all of this to get them paneled individually but then the insurance company rejects their application to be paneled. Then what? lol

 

[PsyDr]

Good point. I think someone I spoke to somewhere else mentioned I could do this as well. I believe in my contractor agreement I mention that they would need to indicate my EIN in their CAQH and in their application to be paneled. I guess my biggest concern is, I go through all of this to get them paneled individually but then the insurance company rejects their application to be paneled. Then what? lol

1) Come on. "all this work"? It’s like 4hrs of work.
2) They cannot use your EIN, because that is not their EIN. They have to use a "reassignment of benefits".
3) if they can’t get paneled with one insurance, then you don’t send those patients to them.

 

[chicandtoughness]

And if you do 50/50 you're a garbage human just my personal opinion.

There's a well known practice in my area doing 40/60. Yes, that's 40 to the clinician. Disgusting.

 

[PsySeeker]

You get a clinic NPI, then have your colleagues fill out a reassignment of reimbursement form. Then you pay them according to their contract.

Reminder: Unfair payment arrangement, including 50/50, is unethical and a BAD business plan. It is MUCH smarter to pay 75/25, let them create a panel of patients, make them want to stay because it is cheaper to stay with you than start a competing business, and create long term profits.

To your point, the place I did my post-doc at insisted on a flat rate of $40 per hour of therapy on 1099 contract and were initially not at all transparent about their reimbursement rates. Eventually, when I became license eligible, they moved to a 60/40 split, and, after more than a year of full time work there, I could finally see that my average split had been little more than 29% during post-doc. At this point the owner discussed making me clinical director of the practice and was initially offered 50k flat salary with no benefits, I refused. Post-licensure I was bumped to 70/30 but within a month or so the owner started slow paying me and tried to cut my split back because I had a very large caseload, was carrying the practice out of necessity at the time, and was therefore, ostensibly, costing too much money, I refused. Over the course of the next six months or so it became clearer and clearer there was resentment towards me and that I wasn't really welcome there/being pushed out. So I launched my own private practice and resigned within a few months. I haven't looked back since.

 

[PsyDr]

To your point, the place I did my post-doc at insisted on a flat rate of $40 per hour of therapy on 1099 contract and were initially not at all transparent about their reimbursement rates. Eventually, when I became license eligible, they moved to a 60/40 split, and, after more than a year of full time work there, I could finally see that my average split had been little more than 29% during post-doc. At this point the owner discussed making me clinical director of the practice and was initially offered 50k flat salary with no benefits, I refused. Post-licensure I was bumped to 70/30 but within a month or so the owner started slow paying me and tried to cut my split back because I had a very large caseload, was carrying the practice out of necessity at the time, and was therefore, ostensibly, costing too much money, I refused. Over the course of the next six months or so it became clearer and clearer there was resentment towards me and that I wasn't really welcome there/being pushed out. So I launched my own private practice and resigned within a few months. I haven't looked back since.

Watch this: If they paid you at a 75/25 cut, they would have pocketed about $35k/yr. They could have incentivized the cut, so that you were paid a higher percentage, after meeting productivity goals. That additional incentive might have netted them another $5k. Over 10 years, they would have netted $400k from an employee. That same employee, if shown the books, might be feel they are treated fair, feel like they have agency to earn more. Anyone who wanted to go into PP would notice the overhead and billing would hit 25%, limiting their desire to leave. After 3 years, if they wanted to sell their company, or get a line of credit, that ONE contract would increase business valuation by approximately $120k. Other business lines of credit, which require a business plan that outlines competition, would notice the lack of competition.

Instead they chose to pay poorly, introduce competition into the market, lose some patients, lose out on that passive income. If they went to sell their business, the competition would lower their business valuation.

 

[Sanman]

Watch this: If they paid you at a 75/25 cut, they would have pocketed about $35k/yr. They could have incentivized the cut, so that you were paid a higher percentage, after meeting productivity goals. That additional incentive might have netted them another $5k. Over 10 years, they would have netted $400k from an employee. That same employee, if shown the books, might be feel they are treated fair, feel like they have agency to earn more. Anyone who wanted to go into PP would notice the overhead and billing would hit 25%, limiting their desire to leave. After 3 years, if they wanted to sell their company, or get a line of credit, that ONE contract would increase business valuation by approximately $120k. Other business lines of credit, which require a business plan that outlines competition, would notice the lack of competition.

Instead they chose to pay poorly, introduce competition into the market, lose some patients, lose out on that passive income. If they went to sell their business, the competition would lower their business valuation.

Even 70/30 with a jump to 75/25 above the rvu cap would keep most folks happy. Yet, I see more predatory practices than good ones. Add to that the constant drama of burning through employees and that became the reason I left my old job. I got tired of fixing ownership created customer service issues.

 

[texanpsychdoc]

Watch this: If they paid you at a 75/25 cut, they would have pocketed about $35k/yr. They could have incentivized the cut, so that you were paid a higher percentage, after meeting productivity goals. That additional incentive might have netted them another $5k. Over 10 years, they would have netted $400k from an employee. That same employee, if shown the books, might be feel they are treated fair, feel like they have agency to earn more. Anyone who wanted to go into PP would notice the overhead and billing would hit 25%, limiting their desire to leave. After 3 years, if they wanted to sell their company, or get a line of credit, that ONE contract would increase business valuation by approximately $120k. Other business lines of credit, which require a business plan that outlines competition, would notice the lack of competition.

Instead they chose to pay poorly, introduce competition into the market, lose some patients, lose out on that passive income. If they went to sell their business, the competition would lower their business valuation.

Indeed - right now I am advertising for psychologists and psychiatrists with a 75/25 split and will handle their application to get paneled with insurances. My thinking is I can add on more providers and skim a little from each one so that they feel valued and are paid what they are actually worth. This is passive income, I am not relying on just a handful of folks to profit off of. My eventual goal is to have enough providers on board where I wouldn't have to work if I didn't want to.

 

[mypointlesspov]

Not to hijack the thread, but I'm wondering what you all think is a fair split for a W2 position with benefits (health care, 401k contribution)?

 

[WisNeuro]

Not to hijack the thread, but I'm wondering what you all think is a fair split for a W2 position with benefits (health care, 401k contribution)?

Depends on your RVU production/billing. The split has to make sense when it comes to overhead (logistical overhead + your salary +benefit cost).

 

[PsySeeker]

Watch this: If they paid you at a 75/25 cut, they would have pocketed about $35k/yr. They could have incentivized the cut, so that you were paid a higher percentage, after meeting productivity goals. That additional incentive might have netted them another $5k. Over 10 years, they would have netted $400k from an employee. That same employee, if shown the books, might be feel they are treated fair, feel like they have agency to earn more. Anyone who wanted to go into PP would notice the overhead and billing would hit 25%, limiting their desire to leave. After 3 years, if they wanted to sell their company, or get a line of credit, that ONE contract would increase business valuation by approximately $120k. Other business lines of credit, which require a business plan that outlines competition, would notice the lack of competition.

Instead they chose to pay poorly, introduce competition into the market, lose some patients, lose out on that passive income. If they went to sell their business, the competition would lower their business valuation.

I know. It was disgusting, I honestly still resent them for it when I think about it (thanks forum, ha!), although ultimately I became richer for it, have greater autonomy. Their behavior certainly pushed me out of the nest, so to speak. At the time I needed to get my license, which is a vulnerable period in my area as it's difficult to get the requisite 2000 or so post doc hours here for various reasons, and even though they got full fee on everything I did they paid me less than half of a low end fair amount, I assume because of greed, and perhaps because they thought folks in my position at the time would not catch on to just how unfair it was, I really don't know what would make anyone think that model is good for anyone, their practice included. This is still the model there btw, I can think of approximately 5 folks that I knew that left there on bad terms and ultimately struck out on their own. They also saddled me with a nasty non-compete that would have been better used as toilet paper.

I know of several other practices that have absolutely nasty non-compete clauses as well as nasty early termination fees on top of the crap split. E.g. if you try to leave before the end of your year or two they try to extract several months of prior pay from you, lovely stuff.

 

[texanpsychdoc]

I know. It was disgusting, I honestly still resent them for it when I think about it (thanks forum, ha!), although ultimately I became richer for it, have greater autonomy. Their behavior certainly pushed me out of the nest, so to speak. At the time I needed to get my license, which is a vulnerable period in my area as it's difficult to get the requisite 2000 or so post doc hours here for various reasons, and even though they got full fee on everything I did they paid me less than half of a low end fair amount, I assume because of greed, and perhaps because they thought folks in my position at the time would not catch on to just how unfair it was, I really don't know what would make anyone think that model is good for anyone, their practice included. This is still the model there btw, I can think of approximately 5 folks that I knew that left there on bad terms and ultimately struck out on their own. They also saddled me with a nasty non-compete that would have been better used as toilet paper.

I know of several other practices that have absolutely nasty non-compete clauses as well as nasty early termination fees on top of the crap split. E.g. if you try to leave before the end of your year or two they try to extract several months of prior pay from you, lovely stuff.

It's very hard for someone to legally uphold a non-compete (so I've been told). Alternatively, in my practice, this is what I offer:

• 75/25% split of fees collected from services (i.e., you take 75%, we take 25%)
• Steady stream of referrals
• 100% remote work
• Flexible scheduling (you work as much or as little as you want)
• We get you credentialed with the insurance companies we are contracted with
• A very intuitive and easy-to-use portal and EHR system to complete all of your documentation, scheduling, and accepting of payments
• We take care of all of the insurance claims
• We do not have non-compete clauses in our contracts

I was considering adding a paid Psychology Today profile and $500 annually for CEUs.

 

[WisNeuro]

It's very hard for someone to legally uphold a non-compete (so I've been told). Alternatively, in my practice, this is what I offer:

• 75/25% split of fees collected from services (i.e., you take 75%, we take 25%)
• Steady stream of referrals
• 100% remote work
• Flexible scheduling (you work as much or as little as you want)
• We get you credentialed with the insurance companies we are contracted with
• A very intuitive and easy-to-use portal and EHR system to complete all of your documentation, scheduling, and accepting of payments
• We take care of all of the insurance claims
• We do not have non-compete clauses in our contracts

I was considering adding a free paid Psychology Today profile and $500 annually for CEUs.

Depends on the non-compete. In the words of a lawyer who looks over my contracts, "My kids college and my house is paid for by litigating and enforcing non-competes." Though, we'll have to see what is coming down the pipe with some proposals from the FTC, as well as several states advancing legislation curtailing the practice.

 

[PsySeeker]

It's very hard for someone to legally uphold a non-compete (so I've been told). Alternatively, in my practice, this is what I offer:

• 75/25% split of fees collected from services (i.e., you take 75%, we take 25%)
• Steady stream of referrals
• 100% remote work
• Flexible scheduling (you work as much or as little as you want)
• We get you credentialed with the insurance companies we are contracted with
• A very intuitive and easy-to-use portal and EHR system to complete all of your documentation, scheduling, and accepting of payments
• We take care of all of the insurance claims
• We do not have non-compete clauses in our contracts

I was considering adding a free paid Psychology Today profile and $500 annually for CEUs.

I believe you will ultimately make a lot of money and be very successful across multiple spheres and feel good about it too.

 

[Sanman]

Depends on the non-compete. In the words of a lawyer who looks over my contracts, "My kids college and my house is paid for by litigating and enforcing non-competes." Though, we'll have to see what is coming down the pipe with some proposals from the FTC, as well as several states advancing legislation curtailing the practice.

The thing about non-compete clauses is that while they might be unenforceable in many (most) cases, the legal fees are often enough to tank a fledgling business even if they find for you, which is the goal.

 

[texanpsychdoc]

I believe you will ultimately make a lot of money and be very successful across multiple spheres and feel good about it too.

It's my hope. I want to be able to balance providing the latitude and earning potential for my associates you wouldn't get in large healthcare organizations. I am designing my practice not only with my sights on the clinical side, but an atmosphere that would attract and retain great quality clinicians so I can achieve my goals of practicing how I want to, have the flexibility to do what I want, when I want, to work less and earn more. I don't need to rob my associates of their money to do that.

 

[PsyDr]

Little tip: "What do you want to accomplish this year? It can be professional, it can be personal. What can I do to make that happen?"

That will earn you more loyalty than you can ever imagine.

 

[oldschooliscool]

Can someone help me understand something? Still on internship at the moment, but I'm finally giving the logistics of a private practice some attention and thought:
Let's say you start a private practice on your own. After a few years, you start building a group practice, with the goal of moving towards you not working much at all while the other clinicians you've brought on providing you a modest passive income.
What value are you bringing to the table? I'm not talking about "value" as in morally or whatever, I'm just curious about the economics of it. Why do they work with you? Do you have a credential that they don't that makes all of this possible?
Really wanting to learn here, any explanations would be appreciated!

 

[WisNeuro]

Can someone help me understand something? Still on internship at the moment, but I'm finally giving the logistics of a private practice some attention and thought:
Let's say you start a private practice on your own. After a few years, you start building a group practice, with the goal of moving towards you not working much at all while the other clinicians you've brought on providing you a modest passive income.
What value are you bringing to the table? I'm not talking about "value" as in morally or whatever, I'm just curious about the economics of it. Why do they work with you? Do you have a credential that they don't that makes all of this possible?
Really wanting to learn here, any explanations would be appreciated!

Many people simply do not like handling the business and logistics of a private practice. It's really that simple in most cases.

 

[AcronymAllergy]

Can someone help me understand something? Still on internship at the moment, but I'm finally giving the logistics of a private practice some attention and thought:
Let's say you start a private practice on your own. After a few years, you start building a group practice, with the goal of moving towards you not working much at all while the other clinicians you've brought on providing you a modest passive income.
What value are you bringing to the table? I'm not talking about "value" as in morally or whatever, I'm just curious about the economics of it. Why do they work with you? Do you have a credential that they don't that makes all of this possible?
Really wanting to learn here, any explanations would be appreciated!

It depends on each practice's setup, but there can be multiple things the practice owner brings to the table: office space, administrative support (e.g., billing, scheduling, handling incoming calls, sending reports to referral sources), referral sources/relationships, managing all the business-related aspects of owning and running a practice (e.g., keeping the books), providing testing and other general office supplies, etc.

At the end of the day, it's easier for the provider to join an existing practice, where they basically just show up and make money, than to start everything from scratch themselves. Hence why the practice owner gets a portion of what the providers bill.

Edit: and like WisNeuro said, even if all of the aspects of running a practice aren't necessarily complicated (although some can be), they take time, energy, and knowledge, and a lot of providers simply have no desire or interest in it.

 

[oldschooliscool]

Many people simply do not like handling the business and logistics of a private practice. It's really that simple in most cases.

It depends on each practice's setup, but there can be multiple things the practice owner brings to the table: office space, administrative support (e.g., billing, scheduling, handling incoming calls, sending reports to referral sources), referral sources/relationships, managing all the business-related aspects of owning and running a practice (e.g., keeping the books), providing testing and other general office supplies, etc.

At the end of the day, it's easier for the provider to join an existing practice, where they basically just show up and make money, than to start everything from scratch themselves. Hence why the practice owner gets a portion of what the providers bill.

Edit: and like WisNeuro said, even if all of the aspects of running a practice aren't necessarily complicated (although some can be), they take time, energy, and knowledge, and a lot of providers simply have no desire or interest in it.

Thanks to you both for explaining your thinking here! I find this fascinating. It definitely tracks based on what I've seen (a lot of people hate having to figure things out that seem "scary" - like billing), but it amazes me that someone could make a group practice where they get a cut if the group practice is 100% remote and uses something like SimplePractice. It seems to me like platforms like SimplePractice or whatever else is the competition makes setting up a practice easy, so why join a group one if the group one is 100% remote and uses them anyway?

 

[WisNeuro]

Thanks to you both for explaining your thinking here! I find this fascinating. It definitely tracks based on what I've seen (a lot of people hate having to figure things out that seem "scary" - like billing), but it amazes me that someone could make a group practice where they get a cut if the group practice is 100% remote and uses something like SimplePractice. It seems to me like platforms like SimplePractice or whatever else is the competition makes setting up a practice easy, so why join a group one if the group one is 100% remote and uses them anyway?

Still have to deal with billing, business taxes, legal issues, etc. Some people just want to do work and get a paycheck.

 

[AcronymAllergy]

Still have to deal with billing, business taxes, legal issues, etc. Some people just want to do work and get a paycheck.

Yep. And you may also have folks who want to work part-time and they may not see the investment of setting up their own practice as worthwhile.

 

[texanpsychdoc]

Thanks to you both for explaining your thinking here! I find this fascinating. It definitely tracks based on what I've seen (a lot of people hate having to figure things out that seem "scary" - like billing), but it amazes me that someone could make a group practice where they get a cut if the group practice is 100% remote and uses something like SimplePractice. It seems to me like platforms like SimplePractice or whatever else is the competition makes setting up a practice easy, so why join a group one if the group one is 100% remote and uses them anyway?

Again....if they could do it, then why aren't they? There is a lot more involved than taking 5 minutes out of your schedule to create a SP account to build and run a profitable online group private practice. That is how I run my practice - it is a business, not a charity. No one is entitled to anything. If they think they can do better, earn more, etc., I very much encourage them to go do so.

 

[oldschooliscool]

Again....if they could do it, then why aren't they? There is a lot more involved than taking 5 minutes out of your schedule to create a SP account to build and run a profitable online group private practice. That is how I run my practice - it is a business, not a charity. No one is entitled to anything. If they think they can do better, earn more, etc., I very much encourage them to go do so.

I still have 10 months left in my internship, followed by the inevitable post-doc, so I'm still a couple years away from setting up my own practice. But what resources would you recommend I look into to start learning what's required? Everyone I've spoken to on internship or in grad school didn't really know where to steer me. Are there certain checklists you've followed, or websites you've read, or videos you've watched? Any help would be so appreciated!

 

[PsyDWannabe]

Yep. And you may also have folks who want to work part-time and they may not see the investment of setting up their own practice as worthwhile.

This is a major point. Quite a few contractors of group practices are just that: contractors. They are not full-time employees with benefits, nor do they want to be because they enjoy the flexibility of working as little as they want to and whenever they want to. Can’t do that at a full-time job with benefits, or even as the owner of the practice (at least in the beginning).

 

[texanpsychdoc]

I still have 10 months left in my internship, followed by the inevitable post-doc, so I'm still a couple years away from setting up my own practice. But what resources would you recommend I look into to start learning what's required? Everyone I've spoken to on internship or in grad school didn't really know where to steer me. Are there certain checklists you've followed, or websites you've read, or videos you've watched? Any help would be so appreciated!

There wasn't a single source or thing I referenced per se - I am very business-minded (I have had businesses before, and I also had a private practice back in Ohio I started like 4 months after internship/getting licensed). I do a lot of research on places like Youtube, I read articles online from others who have started successful businesses. I do my own web design, marketing, etc., so I do a lot of research in areas of SEO, marketing, web-design, and many other aspects involved with owning and operating a business. I am literally a one man show, so I do my own scheduling, screening prospective patients, created my own templates, consent forms, etc.; I applied for the insurances on my own (I did not pay a 3rd party company to apply for them on my behalf). I have taught myself a lot of aspects of using insurance, billing, etc. I am still learning. A big part of being a business owner is having a healthy sense of curiosity to explore/learn new things, refine as you go, adapt from others who have been successful, but also put your own stamp on things. This is my baby, so I have complete control over my brand, how things operate, and providing a solid customer experience. My work in the VA as well as my own experiences receiving healthcare services have shown me what I like and do not like in terms of patient/customer care. Remember, there are plenty of options for folks out there, so there is a lot of salesmanship going on, especially if you elect to be a cash pay practice. I would recommend considering what it is you hope to get out of private practice vs. what you could get working for an organization or a group practice. Knowing your values will help guide you in your decisions as a business owner. For example, I've recently turned down some pretty lucrative contract options for forensic work as well as with a major referral source/organization because they significantly diverged from my values. I have a lot of options in my practice where I can afford to turn away more people than I accept. I am not desperate. Consider these things as you venture out into yours. Hope this helps.

 

[oldschooliscool]

There wasn't a single source or thing I referenced per se - I am very business-minded (I have had businesses before, and I also had a private practice back in Ohio I started like 4 months after internship/getting licensed). I do a lot of research on places like Youtube, I read articles online from others who have started successful businesses. I do my own web design, marketing, etc., so I do a lot of research in areas of SEO, marketing, web-design, and many other aspects involved with owning and operating a business. I am literally a one man show, so I do my own scheduling, screening prospective patients, created my own templates, consent forms, etc.; I applied for the insurances on my own (I did not pay a 3rd party company to apply for them on my behalf). I have taught myself a lot of aspects of using insurance, billing, etc. I am still learning. A big part of being a business owner is having a healthy sense of curiosity to explore/learn new things, refine as you go, adapt from others who have been successful, but also put your own stamp on things. This is my baby, so I have complete control over my brand, how things operate, and providing a solid customer experience. My work in the VA as well as my own experiences receiving healthcare services have shown me what I like and do not like in terms of patient/customer care. Remember, there are plenty of options for folks out there, so there is a lot of salesmanship going on, especially if you elect to be a cash pay practice. I would recommend considering what it is you hope to get out of private practice vs. what you could get working for an organization or a group practice. Knowing your values will help guide you in your decisions as a business owner. For example, I've recently turned down some pretty lucrative contract options for forensic work as well as with a major referral source/organization because they significantly diverged from my values. I have a lot of options in my practice where I can afford to turn away more people than I accept. I am not desperate. Consider these things as you venture out into yours. Hope this helps.

This was really helpful, thanks for taking the time to type it all out! Seriously, this was a big help.

 

[smalltownpsych]

Less value for licensed psychologists since we are pretty experienced by the time we are licensed but a lot of the midlevels appreciate clinical consultation from an experienced psychologist so that adds some value. If they don’t value that, then I probably don’t want them to be part of my practice.