A private PMHNP practice

[Oldmahubbard]

I thought my experience in opening a practice psychiatric practice (with an MD) a few years ago might be helpful.

Can a PMHNP make a reasonable income in private practice? Potentially, but there is a definite learning curve. Here are a few thoughts.

First, a survey of the lay of the land. If you live in an area where enough people have the income to pay out of pocket, you can stop reading right now. Good luck with that, we attempted it in a low cost living area, and got nowhere. I hear the weather is fabulous in San Francisco!

Our practice only took about 2 years to become profitable after we started to accept insurance. It could have been faster, but we were both working other places. The practice was part-time. We didn't advertise, or otherwise network, but word of mouth about the practice spread quickly.

My perspective : NP's desiring to open a private practice should have an income cushion of some kind, a part-time job, a partner with a good job, or savings. This is possibly more do-able than it sounds, but it is assuredly a long term project. You probably cannot just leave your current position, start a practice, and see a good income a year later.

With that in mind, the prospective private practice NP should save up some cash while doing the initial practice research. Get used to living on less for awhile. Perhaps you will need to keep the old car, forego meals out, vacations, or whatever it takes to build up a cushion. A business loan will still be necessary, but you should avoid going into debt too deeply for day to day living expenses.

Learn about the local therapists and visit them. Invite them out to lunch, do what it takes to find out who are good referrals.

When you are ready to actually start your practice, it will take time before it is up and running. You will have to balance other income producing activities, and practice networking.

From the start, you will need a professional office manager. This is not a minimum wage employee. A person with medical office management experience will save you their salary many times over. Furthermore, their salary is a tax-deductible business expense.

Now for the bad news. You have already decided that you are accepting insurance, with all that it entails. Your office manager should handle most of the real nonsense for you.

The practice model that works is seeing 3 patients an hour. Before you scream and shout, understand that 40% of patients won't even keep their first appointment, and about 25% of patients won't keep their appointments from there on in. Many people will be looking for a magic answers, controlled drugs of various stripes, or disability payments.

Hopefully, you have enough mental health experience to have these types of issues resolved in your mind. Understand I am not saying that no one needs narcotics or disability, not at all.

You want to make a reasonable living, so you will need to see 3 patients an hour. My opinion, my experience.

Thankfully, this is much easier than it sounds. Many people don't keep their appointments. Some people come in basically to pick up their scripts.

Most of the others have issue that need to be hashed out with a good therapist. You should have a handful in your treatment orificenal. These are the people you have identified in your pre-practice research.

To see 3 people an hour, you will need to book 4 people an hour. This will become obvious to you after a couple of years in private practice, so don't listen to some stranger on the Internet.

I would love to hear comments and feedback!

[Oldmahubbard]

Part II.

After the practice started making some money, usually seeing 3 patients an hour (there were exceptions), apparently someone complained that they "didn't get enough time". As a result, the MD who owned the practice said we would only book 2 patients an hour. With the usual no show rate, I ended up seeing about 10 patients a day, was no longer making a living, and I heard the practice failed within a year. I left shortly after the "2 patients an hour" rule started.

[NHGN]

Before I write "oh god, this scares the heck out of me!!!!" let me thank you for writing this up! Your experience is very helpful!

I've worked IP, in IOP, at a posh college, and currently at a community clinic. I'm dreaming of opening a [mostly C/A] private practice in a year or two, starting part time at first. Also doing some niche thing with it that includes horses.

Credible sources tell me that child NPs in my local city make $250-500k a year (f/t). I make about $140k now, and I wonder if that low-end of the spectrum would even out to what I make now, when I consider rent, taxes, health insurance, etc.

In my own time, I am a competitive horseback rider. Horse upkeep costs at least $30k a year. Plus a mortgage (I'm single). It all works out to needing a decent salary. I don't mind working hard for the money, but I also want time to actually do things outside of work!

I plan on running things out of pocket (and doing some pro bono things outside of that). Although I live in CT now, I'm very seriously thinking of moving to the Wilmington, DE area. There are definitely some affluent areas based on house prices and vague comments on the internet. Any suggestions on how to see just how affluent? How about seeing if the area is already flooded with child providers? My area is desperate for child providers and I doubt that DE is any different, but I could be wrong! I have done a basic Google search for providers in various towns - there aren't a ton. Do you think if I cold-called pediatricians and asked them about psych referrals and wait lists,etc, they would give me info? That's what I was thinking as a next step.

My only personal connection to private practice is a former classmate who has a practice in Greenwich, CT (aka $$$$). He charges $350 for initial evals and $250 for follow ups. He sees everyone for an hour (both evals and f/us).

Eliza

[RNBSN99]

Eliza, 

You are  a real piece of work.  Read you comment. All you care about is making $$$.  What about your patients?  Do you even care if some may have really bad side effects from your medications or who lives may be ruined by your greed?  You are what’s wrong with health care today and what is really wrong with psychiatry.  You just care about the $$$$.  I hope you get sued.  I hope you get sued and out in prison.  GO back to school for something else.  

[MentalKlarity, BSN, NP]

9 hours ago, RNBSN99 said:

Eliza, 

You are  a real piece of work.  Read you comment. All you care about is making $$$.  What about your patients?  Do you even care if some may have really bad side effects from your medications or who lives may be ruined by your greed?  You are what’s wrong with health care today and what is really wrong with psychiatry.  You just care about the $$$$.  I hope you get sued.  I hope you get sued and out in prison.  GO back to school for something else.  

Eliza is discussing salary and income potential and that's perfectly okay. In fact, if more nurses did this rather than having this martyr complex that we should only work out of a "calling" instead of making a living I'm sure salaries would be much higher. Everytime a nurse mentions salary or negotiations there's always someone there basically shutting them down and saying they shouldn't worry about income at all, only patient care. Providing top quality care is important, but knowing our worth and being adequately compensated for that work is just as important.

[GordonGekko, MSN]

10 hours ago, RNBSN99 said:

Eliza, 

You are  a real piece of work.  Read you comment. All you care about is making $$$.  What about your patients?  Do you even care if some may have really bad side effects from your medications or who lives may be ruined by your greed?  You are what’s wrong with health care today and what is really wrong with psychiatry.  You just care about the $$$$.  I hope you get sued.  I hope you get sued and out in prison.  GO back to school for something else.  

Healthcare is a business.  People need to earn a living.  Go back to school for something else

 

[Hoosier_RN, MSN]

1 hour ago, MentalKlarity said:

if more nurses did this rather than having this martyr complex that we should only work out of a "calling" instead of making a living I'm sure salaries would be much higher

I don't know if salaries would be much higher, but we'd get less persons thinking that they're walking into a cake job with extremely high pay straight out of nursing school (neither of which is true), only to crash and burn within a year or 2, because nursing isn't what they thought it would be. A little research would stop all of that

[Brigi23, BSN]

Mentalklarity, I cannot tell you the amount of times I have seen salary shaming within the nursing community so kudos for bringing some mentalklarity to the convo.  There is no way if this was a group of physicians they would be shaming each other for wanting to make money. Just because Eliza didn’t mention how much she enjoys her patients or the field that is irrelevant . The conversation was about starting up a private practice which is the title of the post. This old school thinking of nurses has got to change if we are ever going to lift each other up instead of living in martyrdom and pushing each other down. You can love your patients and make money, it is very possible.

[bruinpnp]

Look on Youtube for "The Psych NP" and book a consult with him. He is a very good reliable resource. Went into private practice and is doing quite well.