Joining a private practice as a Psych APN, need advice

[aaronspector]

Good morning,

I have been a psych APN in a variety of setting for 10 years. I have been asked to join a psychiatrist who has a private practice, outpatient. Will be starting there 1 day a week. He will be my collaborating physician and he will be providing me office space and administrative assistance including help with billing. As payment, so to speak, he is asking for a % of what I bring in.

What percentage would be fair? I've heard a variety of answers and since he is asking me to come to him with a number for discussion, I'd like to be prepared and neither low ball myself or put him off though I'd rather start on the low side and work up if need be.

Any advice and suggestions would be appreciated, thank you

[Whispera, MSN, RN]

I was in private practice with a group of psychiatrists. I was their psych CNS and did pretty much what they did. The practice charged $80 for an appointment with me (15 to 60 minutes) and I got $30 per hour. I don't think that was a fair cut at all...

[aaronspector]

I was in private practice with a group of psychiatrists. I was their psych CNS and did pretty much what they did. The practice charged $80 for an appointment with me (15 to 60 minutes) and I got $30 per hour. I don't think that was a fair cut at all...

That doesn't sound fair in the slightest, was thinking between 25-40%

ughh that sounds awful

[harmonizer]

At least 60% (your)/40% (his) split. Some psychiatrist would do 70% (your)/30%(his) split of the reimbursement.

I was offered 60(mine)/40 before but I decided not to do it because of limited time per patient. I do not want to do anything less then than 30 min follow-up. I would negotiate for 70%/30%. If he says, it is too much.. then say 60%/40%..

[zmansc, ASN, RN]

70/30 on gross or net? In many industries net is often less than 50%, so I'm curious what the typical % range is for these businesses?

[harmonizer]

I think it is 70/30 of the reimbursement - whatever you get from the insurance. I think it is gross, not factoring in other expenses..

One thing to think about you have to think about no-shows and you being a contractor. You pay more taxes and what you get should make up for the those no-shows.

[aaronspector]

At least 60% (your)/40% (his) split. Some psychiatrist would do 70% (your)/30%(his) split of the reimbursement.

I was offered 60(mine)/40 before but I decided not to do it because of limited time per patient. I do not want to do anything less then than 30 min follow-up. I would negotiate for 70%/30%. If he says, it is too much.. then say 60%/40%..

I think that makes sense, thank you very much

I think it is 70/30 of the reimbursement - whatever you get from the insurance. I think it is gross, not factoring in other expenses..

One thing to think about you have to think about no-shows and you being a contractor. You pay more taxes and what you get should make up for the those no-shows.

yeah I've been trying to factor in my no shows into this, hard to predict...what % of no shows do you see?

[Psychcns]

I did one day per week for 1 1/2 years. I got an hourly rate per patient for meds and therapy. I think it was $40. This was years ago!!

I stopped working there the day no one showed up ( a snowstorm) and I made nothing.

I have worked hourly since.

[zmansc, ASN, RN]

I think it is 70/30 of the reimbursement - whatever you get from the insurance. I think it is gross, not factoring in other expenses..

One thing to think about you have to think about no-shows and you being a contractor. You pay more taxes and what you get should make up for the those no-shows.

So reimbursements would be prior to any expenses taken out, correct? And the practice would be paying all the costs of operating the business, like rent, salaries, utilities, insurance, etc out of their 30%, yes?

Seems like this is a very high risk, low return on investment option from a business perspective. The company has to see the potential to generate additional profits from the arrangement or why bother doing it?

[harmonizer]

So reimbursements would be prior to any expenses taken out, correct? And the practice would be paying all the costs of operating the business, like rent, salaries, utilities, insurance, etc out of their 30%, yes?

Correct... prior to any expenses taken out. Hummmm.....60/40 is the norm from what I heard! and it should be high enough to cover no-show.... I agree 70/30 may be a bit high.. Try 65/35? Remember, earning may seem high to you but remember, you need to cover no-show, instability of being a contractor working for a private psychiatrist, higher tax, and paying for your own benefit. Those are lots of price to pay.

[aaronspector]

Thank you, I think it cannot hurt to at least try for 30/70 and let him haggle if he feels there is reason. Appreciate the advice

[harmonizer]

Also when doing calculation, please taking into account the number of patients seen per hours. He may claim that you will make such and such of dollars per hour if you see # of patients. He may claim that you will make good money with certain percentage but then you have to see 3 patient per hours or only have 30 min intial eval. Please do not fall into this trap. You have to think how much harder you have to work for it. It's fine if you can do fast pace but you should be fairly compensated. Personally, I do not want to be slammed with patients. My experience is that private psychiatrist wants to push patients to be seen quickly. There more patients you see, the more profit they will earn.

Last time I worked locums at a community health center and ended up seeing only 4 patients for the whole 8 hr shift. I know that my hour rate is pretty low. But imagine how much less I would earn if I get paid per patients.