Private Practice Questions

[u/Ebb_flow_22]

What are things you wish you knew or were happy you did when you started your private practice? Any book recommendations or things to consider? Private pay, sliding scale and Telehealth is the current starting idea. I do not have anything set in stone so it’s all planning stages and dreams at this point. Thanks in advance.

[u/CapableCan1842]

Take care of (cherish!) your referral sources. Return phone calls quickly, be prepared whenever you talk to him/her, quick turn around time on reports, accurate billing, send Christmas cards, occassional lunches, etc. It is so much easier to protect and keep a good referral source than it is to get another one.

My practice was primarily assessment. Quality is the best advertisment. From start to finish, I made an effort to make everything easy for the client/referral source. A real (friendly) person answering the phone, don't keep the client waiting, offer them coffee, soft drinks, a professional report free of typos emailed withing a few days of seeing the client. A follow up email or phone call to see if the client or referral source had any questions.

It's not just about being a good psychologist. The other things matter.

[u/Masnpip]

you really have to embrace the mindset of an entrepreneur/sales person/business owner. I had sublets within my office suite for years, and had a stream of aspiring private practitioners come through.

The majority who failed just couldn’t get it in their heads that at least half of their job was now business owner, not therapist. That includes unashamedly billing for And Collecting fees, hustling to drum up business, actually spending money on advertising, but not being silly about how much, learning about taxes, scheming new ways to grow the business.

It also includes an awareness of the business impact of some choices. I have seen providers tell a really solid referral source that they were full at the moment, and then were surprised when that referral never sent anyone else their way. Or providers being slow to return phone calls to referral sources or potential clients, and then wonder why things were drying up. Or having too many limits early on to who they’d see. Specializing is a good idea to get your name out there with a couple of niche populations, but you can’t overdo that.

A good business mindset also includes thinking about marketing carefully. Not just where to place ads. But also marketing broadly. For example, think about a couple of specialties, special populations, specific techniques that might be things people google. And then learn how to make your web site show up when people google that.

A key for me for the first 5 or so years was that I had a rule that I was always working during work hours. So if I was not seeing a client, I was tweaking my web site or schmoozing a referral sources, or cleaning my office. You are not building your business if you’re taking a nap on a slow Tuesday afternoon.

[u/Masnpip → u/Masnpip]

PS, private pay, sliding scale is the way I personally would go, with a mix of telehealth and in person if I was starting from scratch and if I could afford it. When I was filling my schedule in the beginning, I thought, “this client is paying me less than my full fee, but that ($whatever) is a lot more than the zero dollars I’d make if I were sitting at home.

Others choose to get credentialed so they are in network with numerous health insurance companies so that they have a full client load with more ease.

Others choose to bill insurance on behalf of their clients, but remain out of network.

The decision on which way to go is up to you, how fast or slow you can tolerate building your practice, and what your local supply and demand looks like.

[u/unicornofdemocracy]

Deduct It!: Lower Your Small Business Taxes by Stephen Fishman

Very good book that's easy to read and really breaks down all the options and deductions accurately for you.

[u/Affectionate-Bad4890]

I'll represent another side. Private pay sounds good, but if you get on one or two insurance panels, you will get steady calls, and a more diverse client base. I am mostly in-person too. You lose a lot of the therapeutic relationship potential on a screen. I take BCBS, Cigna, Medicare, and Tricare. I have some wonderful clients who couldn't afford private pay but are very committed to their mental health treatment. I see active duty military and veterans. It fulfills me to be able to provide quality health care to a greater swath of the population. I have a billing specialist who handles it all and takes 8%. I'm full with a waiting list at all times. Don't spend any money on advertising or marketing. My fee is $175 but I get an average of $130. 

[u/arrrrr_won]

We had an accountant already after an IRS scare associated with some random thing on my spouse’s side, but wow was I happy to have the taxes bit outsourced when I started private practice. I have zero interest in doing that myself.

[u/Heard_Samira]

I’d work out the financial side before you start filling your calendar. What do you need to bring in each month, how many sessions do you realistically want to see, and those kinds of things. That gives you a much better basis for setting your fee and deciding how much of a sliding scale you can comfortably offer.

[u/AnberJyn]

Building Your Ideal Private Practice by psychotherapist and business coach Lynn Grodzki

[u/RkeCouplesTherapist]

Having a great website and a clear niche is really helpful. I have spent a lot of time learning how to maximize SEO and it has really paid off. It takes a while for a website to become searchable, so don’t put it off. Published as soon as possible and you can continue to improve upon it over time.

I am in solo private practice, private pay, mix of in person and telehealth. I absolutely love it.