What is the outpatient psychiatric hourly rate for outpatient work?

[trophyhusband]

I see. Okay. I thought patients would be eager to see any psychiatrist rather than having to wait so long. I'm sure they'd understand that you're very busy providing care to lots of people in the community, and as much as you'd like to do longer visits, its just not possible.

As the person who answers all of my wife's new patient phone inquiries... best of luck with that bolded bit.

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[ObsequiousAplomb]

I see, I meant of the ones that do in person visits, does the psychiatrist physically remain seated in an office room and the patients come in and out as opposed to having exam rooms seeing patients?

Having a ton of exam rooms could be expensive, so I imagine a psychiatrist could set up a large room with some partitions in it and have the patients sit in a cubicle, like maybe 6 patients at a time. Would need to hire someone to keep things flowing. Then the doc could bounce from "room to room" and see the patients. This could be an efficient set up thus allowing many more patients to receive treatment. I think you could see 50 patients a day like this. Have patients fill out a questionnaire before appointment with some SIGECAPS, etc to have a presumptive diagnosis before entering the room. Thoughts?

No. Most psychiatrists walk to the waiting room, then walk the patient back to the room themselves. That way you get a chance to observe the patient in the waiting room and see them get up and walk. There's no real need to have people be roomed by someone else. It's not like you actually need to check vitals. It takes less than 30 seconds.

The wait list is not a bad thing. 6 months to see a psychiatrist means the patients are more likely to have an actual disorder requiring a psychiatrist and not making a same-day appointment after something sad happens and they waste everyone's time. They can see their PCP for the empiric SSRI followed by a second SSRI, see a therapist, work through a self-help workbook, talk to their friends/family/pastor, and after that all fails then the 6 month wait is up and they can see you. If you fill your schedule with people who don't need to see a psychiatrist, then sure, you can make your megamillions you're always asking about while claiming it's to "improve access to care." You know, maybe you should just work for one of those VC-backed companies that all abuse that logic to set up their systems?

 

[michaelrack]

No. Most psychiatrists walk to the waiting room, then walk the patient back to the room themselves. That way you get a chance to observe the patient in the waiting room and see them get up and walk. There's no real need to have people be roomed by someone else. It's not like you actually need to check vitals. It takes less than 30 seconds.

You actually should be checking vitals

 

[forchinet121]

I see, I meant of the ones that do in person visits, does the psychiatrist physically remain seated in an office room and the patients come in and out as opposed to having exam rooms seeing patients?

Having a ton of exam rooms could be expensive, so I imagine a psychiatrist could set up a large room with some partitions in it and have the patients sit in a cubicle, like maybe 6 patients at a time. Would need to hire someone to keep things flowing. Then the doc could bounce from "room to room" and see the patients. This could be an efficient set up thus allowing many more patients to receive treatment. I think you could see 50 patients a day like this. Have patients fill out a questionnaire before appointment with some SIGECAPS, etc to have a presumptive diagnosis before entering the room. Thoughts?

This can’t be real

 

[ObsequiousAplomb]

You actually should be checking vitals

Why? None of the medications I prescribe require routine vitals monitoring.
When I do, I just hand the cuff to the patient and walk them to the scale. It ends up being an extra minute once a year getting them.

 

[forchinet121]

Why? None of the medications I prescribe require routine vitals monitoring.
When I do, I just hand the cuff to the patient and walk them to the scale. It ends up being an extra minute once a year getting them.

Vitals make sense for stimulants mainly

 

[TexasPhysician]

I see. Okay. I thought patients would be eager to see any psychiatrist rather than having to wait so long. I'm sure they'd understand that you're very busy providing care to lots of people in the community, and as much as you'd like to do longer visits, its just not possible.

I’m not sure about all localities, but finding a psychiatrist (especially if willing to pay cash) in Texas isn’t that hard if you aren’t picky. Knowing who has openings, willingness to call around, and Google abilities - you can see a psychiatrist in my state who takes Aetna in a week. You aren’t going to find non-Medicaid patients that will put up with poor practice set-ups unless you are handing out Xanax and Adderall to everyone.

 

[jbomba]

I love how his factory farm psychiatry practice question is phrased under the guise of how to best serve the community. And then the gaslighting when called out on it. That's rich...

 

[hamstergang]

Why? None of the medications I prescribe require routine vitals monitoring.

I don't know what you prescribe, but blood pressure should be checked for SNRIs (direct risk of hypertension) and for antipsychotics (as part of monitoring for metabolic syndrome).

 

[allantois]

I don't know what you prescribe, but blood pressure should be checked for SNRIs (direct risk of hypertension) and for antipsychotics (as part of monitoring for metabolic syndrome).

Not to mention almost all medications can effect weight; unless maybe he’s only prescribing benzos lol

 

[ObsequiousAplomb]

Not to mention almost all medications can effect weight; unless maybe he’s only prescribing benzos lol

Height and weight definitely don't need to be checked every month during initial titration of an SSRI, or even every 3 months. 6 months to a year or whenever there's something in the hpi that suggests it is worth checking like major changes in appetite, feeling of having lost or gained weight, etc.

SNRIs - sure, I check the blood pressure more than I do for SSRIs, especially at higher doses. But every single visit? That would be excessive.

Antipsychotics - yeah, I would be checking height and weight and occasionally blood pressures. But again, not every month and certainly not for people I'm doing weekly meds with therapy for.

Since I mostly do weekly or more frequently med/therapy visits, it would be excessive to check vitals at every visit. Especially when they're following with a PCP.

Once I get people to the Q3 or Q6 month follow-ups, then yeah I would probably come closer to checking vitals most visits. But since I don't do that, I don't.

 

[hamstergang]

it would be excessive to check vitals at every visit. Especially when they're following with a PCP.

The comment was about checking vitals regularly or even at all. No one before this post of yours was talking about checking vitals every visit.

 

[Psychic Meep]

I was recently offered $275 and $265 in the Midwest. Made me question my previous hourly reimbursement as I have been paid less. Looking forward to hearing your numbers.

Many of your posts read like ads for a certain q-bank with a few "normal" posts sprinkled in between. Lots of very short posts and now this thread, almost like there's some padding of your post count going on. Color me skeptical that this is a legit thread, one that you barely participate in

 

[forchinet121]

Many of your posts read like ads for a certain q-bank with a few "normal" posts sprinkled in between. Lots of very short posts and now this thread, almost like there's some padding of your post count going on. Color me skeptical that this is a legit thread, one that you barely participate in

What are you implying lol why would one be trying to increase their post number?

 

[Psychic Meep]

What are you implying lol why would one be trying to increase their post number?

How else would you tell that an account is more likely to be legit than by seeing how long and how active of a member they’ve been? There’s a difference between a long time member with hundreds of posts who endorses a product and a newish one with only a couple dozen posts

 

[Dr.MONO]

I don't know what you prescribe, but blood pressure should be checked for SNRIs (direct risk of hypertension) and for antipsychotics (as part of monitoring for metabolic syndrome).

Do you check the BP yourself or have staff? I am still in residency and they ask us to do it ourselves.

 

[ObsequiousAplomb]

The comment was about checking vitals regularly or even at all. No one before this post of yours was talking about checking vitals every visit.

it was in response to my post before that. He had asked if you need to hire staff to check vitals. I said you don't need to check vitals every visit. People said that I should.

 

[brainmedicine]

Per my experience, no one knows how much is the earning potential unless you ask. Some physicians are not too aggressive when it comes to asking. I recently read on psych network on Facebook a psychiatrist is earning $450 per hour somewhere in MN. She described herself as a prenatal psychiatrist. I would have never imagined such rate.

 

[Mad Jack]

Honestly I can’t imagine having to deal with patient messages directly through a portal
without staff. I have a few who got a hold of my email and it’s been a nightmare to say the least.

I just politely tell them to not use my email, as it is not secure and is not an official means of communication, thus I cannot use it for patient care matters.

 

[Mad Jack]

Per my experience, no one knows how much is the earning potential unless you ask. Some physicians are not too aggressive when it comes to asking. I recently read on psych network on Facebook a psychiatrist is earning $450 per hour somewhere in MN. She described herself as a prenatal psychiatrist. I would have never imagined such rate.

I mean, given that I got an ad for $325/hr doing correctional psych in California, it doesn't seem absurd that someone could make $450/hr treating well-to-do young clients.

 

[jbomba]

Per my experience, no one knows how much is the earning potential unless you ask. Some physicians are not too aggressive when it comes to asking. I recently read on psych network on Facebook a psychiatrist is earning $450 per hour somewhere in MN. She described herself as a prenatal psychiatrist. I would have never imagined such rate.

I'm actually sub specializing in reproductive psych myself as to carve out a private practice niche. Any sense if that 450 was cash or insurance?

Also what was that fb group?

 

[brainmedicine]

I'm actually sub specializing in reproductive psych myself as to carve out a private practice niche. Any sense if that 450 was cash or insurance?

Also what was that fb group?

Psychiatry network

 

[Nudexta]

Per my experience, no one knows how much is the earning potential unless you ask. Some physicians are not too aggressive when it comes to asking. I recently read on psych network on Facebook a psychiatrist is earning $450 per hour somewhere in MN. She described herself as a prenatal psychiatrist. I would have never imagined such rate.

That’s an amazing rate

 

[painballer27]

That’s an amazing rate

But can't most psychiatrists get that doing 2 99214+90833 per hour?

 

[finalpsychyear]

But can't most psychiatrists get that doing 2 99214+90833 per hour?

My ortho/neurosurg friends are making more than what i make in a week easily in 1 day and frequently in 1 case. If your about $ def go for a speciality like that not focused on EM codes that are likely going to be slashed and never keep up with inflation.

 

[TexasPhysician]

But can't most psychiatrists get that doing 2 99214+90833 per hour?

Gross does not equal net

 

[painballer27]

My ortho/neurosurg friends are making more than what i make in a week easily in 1 day and frequently in 1 case. If your about $ def go for a speciality like that not focused on EM codes that are likely going to be slashed and never keep up with inflation.

Sure, what those guys do is very lucrative. But I was actually just asking about the the $450 an hour. It seems feasible in psych with 99214 and add on for therapy.

 

[jbomba]

Gross does not equal net

This is an important point. However if one were running a hybrid model, renting an office a day or two a week, overhead shouldn't be very much at all. If you off load your billing and collections at 7% it seems another 3-5% should take care of the rest (assuming the quoted 450/hr and a full time schedule.)

That's still a net of 600k at 32 hours and 46 weeks a year, at least on paper.

 

[TexasPhysician]

This is an important point. However if one were running a hybrid model, renting an office a day or two a week, overhead shouldn't be very much at all. If you off load your billing and collections at 7% it seems another 3-5% should take care of the rest (assuming the quoted 450/hr and a full time schedule.)

That's still a net of 600k at 32 hours and 46 weeks a year, at least on paper.

That’s a lot of assumptions that won’t hold true. Not every patient can be 99214 or 90833 or both. Additionally there is more proof if you attempt to fudge the numbers (time is stored on tele visits) via tele company. I’m not saying you would fudge the numbers, but if you got behind on documentation and mistakenly billed a 90833 for a 15 min in-person visit that could have been 10 or 25 minutes because you didn’t write down exact times, what proof is against you? On tele, time stamps are proof for insurance complaints about your billing behavior. You’ll have patients that request to be fast because of 1,000 excuses and refuse therapy that day. Will you force it and anger them or drop your hourly revenue by 25%?

You’ll need 1-2 FT staff to manage this caseload. I would prefer 2 as they call in sick or quit and then you have to train if only 1. 1 of my staff worked 40% of last month’s hours due to Covid slowly moving through the family. It will take much longer to build a practice without staff with you returning calls in 1 hour slot each day when the patient may be busy. Where will staff be and how will you ensure productivity with no FT office? I’d rather see 1 extra patient that pays for my staff than waste time doing a PA every day.

Without attentive staff, patients will leave. Those follow up codes become new eval codes that pay much less.

For people that haven’t started a private practice, it looks easy and the numbers seem wonderful. The numbers don’t hold true. While there is more $ than most employed roles, you’ll be spending uncompensated hours managing staff, payroll, accounting meetings, attorney phone calls, etc. You’ll deal with employee hassles and have to fire people. They’ll cut corners if you let them. I’ve had uncompensated days from subpoenas and staff creating legal cases.

A friend of mine has her own office (small) with 1 staff. Over 50% tele. She is quitting pp and closing shop because of all the problems. She prefers less $ and fewer problems. Her staff quit randomly. It’s busy for 1 staff to handle, and other than disgruntled patients, 1 staff alone often gets lonely and frustrated. When staff quits, she works a few extra hours per day returning calls, messages, scheduling, etc. This’ll last 1-2 weeks. Few people actually show to interviews and without thorough background checks, you risk employees that will steal from you. She doesn’t have a 2nd staff to confirm issues and doesn’t like the idea of cameras in her waiting room, so sometimes she fires staff for likely inappropriate things. Her reviews on Google are not good from staff turnover and delays in returning phone calls. This has reduced referrals. Less of the desirable patients want to schedule now.

 

[Jules A]

Sure, what those guys do is very lucrative. But I was actually just asking about the the $450 an hour. It seems feasible in psych with 99214 and add on for therapy.

The few psychiatrists I know making $400-$500 per hour have out of network, boutique practices.

 

[TexasPhysician]

But can't most psychiatrists get that doing 2 99214+90833 per hour?

No. BCBS in my state with negotiating skills will pay about $160 for 99214 + 90833. They are the largest company in my state, so it is more difficult to build an insurance practice without them. That lowers gross hourly rate to $320 in this perceived ideal situation. One company pays even less. One that audits much more pays more. There is one of the top 4 that pays better and audits less. Don’t get caught up in the names because it may be different in every state.

 

[jbomba]

That’s a lot of assumptions that won’t hold true. Not every patient can be 99214 or 90833 or both. Additionally there is more proof if you attempt to fudge the numbers (time is stored on tele visits) via tele company. I’m not saying you would fudge the numbers, but if you got behind on documentation and mistakenly billed a 90833 for a 15 min in-person visit that could have been 10 or 25 minutes because you didn’t write down exact times, what proof is against you? On tele, time stamps are proof for insurance complaints about your billing behavior. You’ll have patients that request to be fast because of 1,000 excuses and refuse therapy that day. Will you force it and anger them or drop your hourly revenue by 25%?

You’ll need 1-2 FT staff to manage this caseload. I would prefer 2 as they call in sick or quit and then you have to train if only 1. 1 of my staff worked 40% of last month’s hours due to Covid slowly moving through the family. It will take much longer to build a practice without staff with you returning calls in 1 hour slot each day when the patient may be busy. Where will staff be and how will you ensure productivity with no FT office? I’d rather see 1 extra patient that pays for my staff than waste time doing a PA every day.

Without attentive staff, patients will leave. Those follow up codes become new eval codes that pay much less.

For people that haven’t started a private practice, it looks easy and the numbers seem wonderful. The numbers don’t hold true. While there is more $ than most employed roles, you’ll be spending uncompensated hours managing staff, payroll, accounting meetings, attorney phone calls, etc. You’ll deal with employee hassles and have to fire people. They’ll cut corners if you let them. I’ve had uncompensated days from subpoenas and staff creating legal cases.

A friend of mine has her own office (small) with 1 staff. Over 50% tele. She is quitting pp and closing shop because of all the problems. She prefers less $ and fewer problems. Her staff quit randomly. It’s busy for 1 staff to handle, and other than disgruntled patients, 1 staff alone often gets lonely and frustrated. When staff quits, she works a few extra hours per day returning calls, messages, scheduling, etc. This’ll last 1-2 weeks. Few people actually show to interviews and without thorough background checks, you risk employees that will steal from you. She doesn’t have a 2nd staff to confirm issues and doesn’t like the idea of cameras in her waiting room, so sometimes she fires staff for likely inappropriate things. Her reviews on Google are not good from staff turnover and delays in returning phone calls. This has reduced referrals. Less of the desirable patients want to schedule now.

I appreciate your insights, you clearly know much more than I do as just pgy4. Regarding the staff - our residency clinic is quite poorly staffed. We answer patient emails, do prior auths, essentially everything. We also carry a full patient load. It seems mostly manageable. If you've got an EMR with self scheduling and you're paying someone for billing, do you really think 2 FT staff is necessary?

FWIW - BCBS in my area pays close to 400 for two 99214 + 90833. Its all very geographic dependent.

 

[Stagg737]

I appreciate your insights, you clearly know much more than I do as just pgy4. Regarding the staff - our residency clinic is quite poorly staffed. We answer patient emails, do prior auths, essentially everything. We also carry a full patient load. It seems mostly manageable. If you've got an EMR with self scheduling and you're paying someone for billing, do you really think 2 FT staff is necessary?

FWIW - BCBS in my area pays close to 400 for two 99214 + 90833. Its all very geographic dependent.

Sure, but keep in mind collecting from insurance companies can be arduous. One of the docs I rotated with in med school had a full time employee who’s job was to harass insurance companies for reimbursement for 3 docs. Sometimes insurance companies just delay reimbursement for months. Do you really want to be personally spending hours a week on the phone with insurance chasing down reimbursement?

 

[clausewitz2]

That’s a lot of assumptions that won’t hold true. Not every patient can be 99214 or 90833 or both. Additionally there is more proof if you attempt to fudge the numbers (time is stored on tele visits) via tele company. I’m not saying you would fudge the numbers, but if you got behind on documentation and mistakenly billed a 90833 for a 15 min in-person visit that could have been 10 or 25 minutes because you didn’t write down exact times, what proof is against you? On tele, time stamps are proof for insurance complaints about your billing behavior. You’ll have patients that request to be fast because of 1,000 excuses and refuse therapy that day. Will you force it and anger them or drop your hourly revenue by 25%?

Most of your post was good stuff with excellent points, but I honestly have not had any serious problems with maintaining a ~90% +90833 rate for my appointments. It's a question of socializing them into it from the get-go and asking questions that aren't simple to answer. I am sure I have lost patients who wanted an in-and-out and be done with it in 12 minutes but my schedule remains full. I also see people pretty regularly, which means there is a bit more of a relationship and they are more inclined to talk about the details rather than just the highlights of what is happening in their lives.

 

[calvnandhobbs68]

That’s a lot of assumptions that won’t hold true. Not every patient can be 99214 or 90833 or both. Additionally there is more proof if you attempt to fudge the numbers (time is stored on tele visits) via tele company. I’m not saying you would fudge the numbers, but if you got behind on documentation and mistakenly billed a 90833 for a 15 min in-person visit that could have been 10 or 25 minutes because you didn’t write down exact times, what proof is against you? On tele, time stamps are proof for insurance complaints about your billing behavior. You’ll have patients that request to be fast because of 1,000 excuses and refuse therapy that day. Will you force it and anger them or drop your hourly revenue by 25%?

I think this is going to be a big thing in the future as insurance companies look for more and more ways to monitor us....built into time/whatever is done on the EMR as well. Tele visits leave an audit trail. Every visit you've ever done has a timestamp of when that connected and disconnected. If you connected at 2:04 and disconnected at 2:25 but then put in your note 2:00-2:30 with psychotherapy from 2:13-2:30...there's proof of this. In person, also not saying you're going to blatantly falsify numbers but if you have appointment slots scheduled for 30 minutes and you see people for most of those 30 minutes but they walk out to schedule their followup at 2:29PM, nobody is going to come in and say you didn't actually see someone for that 30 minutes.

 

[jbomba]

Sure, but keep in mind collecting from insurance companies can be arduous. One of the docs I rotated with in med school had a full time employee who’s job was to harass insurance companies for reimbursement for 3 docs. Sometimes insurance companies just delay reimbursement for months. Do you really want to be personally spending hours a week on the phone with insurance chasing down reimbursement?

My understanding was a good billing company would deal with collection issues like this. Key word being "good".

 

[TexasPhysician]

Most of your post was good stuff with excellent points, but I honestly have not had any serious problems with maintaining a ~90% +90833 rate for my appointments. It's a question of socializing them into it from the get-go and asking questions that aren't simple to answer. I am sure I have lost patients who wanted an in-and-out and be done with it in 12 minutes but my schedule remains full. I also see people pretty regularly, which means there is a bit more of a relationship and they are more inclined to talk about the details rather than just the highlights of what is happening in their lives.

I’m not saying you can strive for this. 90% still means 10% of patients don’t meet that criteria which can significantly effect the estimated posted above.

Tele makes it much easier in my opinion to cut visits short. Almost no one tries to leave early when they are here in person. With tele, I have patients seen during their lunch break, between meetings, at their kid’s sporting events, etc. Setting boundaries helps, but it still happens.

 

[TexasPhysician]

I appreciate your insights, you clearly know much more than I do as just pgy4. Regarding the staff - our residency clinic is quite poorly staffed. We answer patient emails, do prior auths, essentially everything. We also carry a full patient load. It seems mostly manageable. If you've got an EMR with self scheduling and you're paying someone for billing, do you really think 2 FT staff is necessary?

FWIW - BCBS in my area pays close to 400 for two 99214 + 90833. Its all very geographic dependent.

You answer incoming phone calls, answer questions regarding insurance issues, listen to all voicemails to manage problems, etc?

Online scheduling helps. I use it. Many patients don’t want to use it frequently. We tried transitioning patients to doing it online. We ended up with multiple bad reviews from this. If you are an academic clinic that takes every cheap insurance with little competition for those plans, you’ll be fine. Bad reviews won’t matter.

People with good insurance plans believe that physicians should provide a good quality experience. This includes good customer service. Lack that and you’ll get negative reviews. Cash and high paying patients will stop calling. This effects your hourly rate.

Hourly rates with some commercial plans and codes in my area (1 eval or 2 follow-ups) can range from $150-490. Just looking at the numbers, the range is massive. If you are trying to maximize revenue, you want to get and maintain the patients with the best insurance plans that are willing to do brief therapy. Accepting everyone or only people willing to go through your hoops significantly alters your patient pool. This will effect growth and hourly rate.

Obviously there is more than 1 way to run a practice. I’ve just found that having a mild surplus of staff reduces my headaches and improves patient retention. The reduced time for me to handle $15/hr reception work, reduced marketing costs, and retaining good follow-up patients is worth it in my experience.

 

[Stagg737]

My understanding was a good billing company would deal with collection issues like this. Key word being "good".

Sure, but keep in mind they’re keeping 5-10% of your earnings. At the 600k billed mentioned above that’s 30-60k, and that’s ONLY to take care of billing. Are you going to do scheduling, take patient calls, fill out PAs, Room patients, etc on your own? For the same amount you’d paying billing you can hire someone to handle most of that for you who can be in-house.

 

[Bartelby]

That’s a lot of assumptions that won’t hold true.

Great post. I find too often people considering private practice follow a template similar to the following:

1 - Find the maximum billing rate (two 99214 + 90833 per hour)
2 - Assume 100% of your clinical time will be billed at that rate
3 - Assume you fill 100% of your time and maintain a 100% show rate (while never doing intakes, which are billed lower than #1)
4 - Assume very little non-billable work happens
5 - Run the numbers!

I love the enthusiasm for private practice and knowing our own worth, and I agree from what I have seen that PP people can often craft jobs that pay better (with more autonomy) than an employed position. But it's good to have posts like the above giving a reality check, things like a $600k/yr solo no-staff insurance practice with a normal 9-5 M-F workweek I have never seen in real life.

 

[calvnandhobbs68]

Just following up on the telemedicine stuff, here’s an actual post from the private practice Facebook group today:

“Post-2020, 2/3 of my practice has switched to phone/televisit. I reserve time slots for people in advance and they know the price. I have a subset of people who, upon seeing the length of time on the phone/televisit, demand a partial refund. Yesterday the mother turned on the lights to wake the sleeping teenage patient who had zero words for me, just a few grunts, then called back to say that the appt was short and mom wanted a partial refund. My opinion is that I reserved this time and you went in knowing how long/how much it would be and if you waste it or don't want it, it's your problem. How do you handle these situations? TIA.”

 

[JKinSC]

FWIW - BCBS in my area pays close to 400 for two 99214 + 90833. Its all very geographic dependent.

Make sure that BCBS will pay you the same rate. At least where I am, it is provider dependent, and based on time on the panel and overall usage. That's of course, assuming that you don't going a large group, in which case you have a little more bargaining power.

 

[jbomba]

Make sure that BCBS will pay you the same rate. At least where I am, it is provider dependent, and based on time on the panel and overall usage. That's of course, assuming that you don't going a large group, in which case you have a little more bargaining power.

Good point. Fwiw I get that number from a recent grad from my program.

 

[Orgone]

Great post. I find too often people considering private practice follow a template similar to the following:

1 - Find the maximum billing rate (two 99214 + 90833 per hour)
2 - Assume 100% of your clinical time will be billed at that rate
3 - Assume you fill 100% of your time and maintain a 100% show rate (while never doing intakes, which are billed lower than #1)
4 - Assume very little non-billable work happens
5 - Run the numbers!

I love the enthusiasm for private practice and knowing our own worth, and I agree from what I have seen that PP people can often craft jobs that pay better (with more autonomy) than an employed position. But it's good to have posts like the above giving a reality check, things like a $600k/yr solo no-staff insurance practice with a normal 9-5 M-F workweek I have never seen in real life.

This should be a sticky. It was my experience, both the over-optimism when starting a practice, discovering that what "pencils" is not always reality, and finally that while the reality will be more complicated, there are still great opportunities depending on one's market, skills, and effort.

 

[Dr. ADT]

Any one hiring therapists in their practice? We are hiring but can not find one for the last 3 months.

 

[clozareal]

Per my experience, no one knows how much is the earning potential unless you ask. Some physicians are not too aggressive when it comes to asking. I recently read on psych network on Facebook a psychiatrist is earning $450 per hour somewhere in MN. She described herself as a prenatal psychiatrist. I would have never imagined such rate.

Well you're going to be shocked to discover that some people are charging >$1000/hr cash only in certain areas of the country and are mostly full (and by full, they work 20-24 hours a week and only do hourly or 1.5 hour appointments at a time, no 30 minute visits). One person I know charges for medication refills outside of appointment times. That's highway robbery to me.

 

[liquidshadow22]

Well you're going to be shocked to discover that some people are charging >$1000/hr cash only in certain areas of the country and are mostly full (and by full, they work 20-24 hours a week and only do hourly or 1.5 hour appointments at a time, no 30 minute visits). One person I know charges for medication refills outside of appointment times. That's highway robbery to me.

What upper east side manhattan or silicon valley? Cant do this anywhere else.

 

[jbomba]

Well you're going to be shocked to discover that some people are charging >$1000/hr cash only in certain areas of the country and are mostly full (and by full, they work 20-24 hours a week and only do hourly or 1.5 hour appointments at a time, no 30 minute visits). One person I know charges for medication refills outside of appointment times. That's highway robbery to me.

I wonder how many of these individuals are charging this rate because they are Ivy (or similar) grads?

As I mentioned above, I will have received sub-specialized training in reproductive psych by the time I finish pgy4 with some really fantastic attendings. Generally speaking, I've got great training at a solid academic institution though definitely not an Ivy level name. I'm pretty sure my patients like me, I'm affable, and if I may say so, I know my stuff and do good work for my patients.

Despite all this, would it be ridiculous to start charging high fees out of the gate; 6-700/hr? I'll be in a very HCOL area with a population who could afford that. Ive always been a good networker and will have a side gig that will allow me to pull patients into my practice. I just don't know if my lack of Ivy background is going to make this a losing proposition. Any thoughts?

 

[Nudexta]

Well you're going to be shocked to discover that some people are charging >$1000/hr cash only in certain areas of the country and are mostly full (and by full, they work 20-24 hours a week and only do hourly or 1.5 hour appointments at a time, no 30 minute visits). One person I know charges for medication refills outside of appointment times. That's highway robbery to me.

What a waste of money to spend all that on just one visit

 

[ObsequiousAplomb]

What upper east side manhattan or silicon valley? Cant do this anywhere else.

Definitely happens in DC as well. And to address jbomba, no, it has nothing to do with being Ivy league.