Psych Private Practice, What's Realistic?

Specialties NP

Updated:   Published

Hi all -

I've skimmed through a search on this topic and past information has been helpful, although most threads are a few years old.

I am a psych NP, I have two years' experience in a young adult IOP, I round on weekends per diem in adult units, and I have about five months' experience in my current position working with C/A in an outpt community clinic. I also work once a week at a local college counseling center as an independent contractor providing med management.

My five-year goal is to incorporate the use of horses in my practice. I also expect to be making more money to support my personal horse hobby.

In the most urban areas of Connecticut (where I live), I have it on good, though vague, authority that psych NPs who see children in their private, out of pocket only, practices bring in $250-600k a year (net). When I say 'vague' I mean I do not know if these people are seeing 30 kids a day and and just pumping out medications (neither of which I'd like to do).

Right now, I make $67/hr (salaried) at my main job, and $180/hr (not including any taxes whatsoever) at my 8hr/wk college job. (A) While this is less than $250k a year, I realize there are many more fees I'd have to cover in private practice. (B) My opinion is that, even before taxes, the $180/hr rate I get is pretty spectacular (I inherited the position from a physician and the college didn't feel a need to change the rate).

For those of you with more experience than me.... If I could take a [likely unrealistic] magic wand and choose my future, I'd like to do a private practice with children and adolescents, not take insurance, see less than 15 pts a day, and bring in $300k after expenses. I'd like to do some therapy (hence the horse), but also refer to a good therapist. Things I'm worried about (besides this being realistic, salary-wise), include shouldering liability and responsibility (I've always worked with a team), and feeling isolated/lonely/non-social if my practice is just me! I'm happy to work alongside other people, but I have it in my head that this will detract from income.

I feel I'm taking a risk putting this thread out here and may get some criticism. This is a way for me to try to sort out my thoughts and goals. I want to make sure I'm safe and providing good services, but horses are a big part of my life and can easily cost $100k for the actual horse and $40k/year in upkeep. I'm single and my goal is to be able to afford that and still live comfortably!

Are there any NPs out there that have a successful and profitable practice? Do you have any wisdom you could impart on me? This thread is a bit non-specific in its questions, I know!

Thanks!

Eliza

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Specializes in Family Nurse Practitioner.

Bummer that you are concerned about criticism because at least for me that is often the way I learn and sort thoughts out best. Glad you wrote as you have good questions that should be addressed prior to just winging it. Your regular rate, in my area would be considered very low but your 1099 rate is excellent.

If you are talking about doing a cash practice the two NPs I know who do this are billing in the $200 an hour range so definitely doable it just takes time to build up your practice. I'd urge you to hire or bring on as partners a couple of skilled therapists who you have worked with and know well because having their support will take a significant load off your plate timewise. They should be billing at least $125-150 an hour for their services. I'd advise against trying to do it all to avoid having expenditures as this population will expect, rightly so, the Saks 5th Avenue service and it will be exhausting to attempt solo, imo. It is really more profitable for the NP to do medication management and let therapists do therapy. This is also usually more productive as patients tend to be more wiling to attend therapy if it isn't as expensive and in most cases, especially with CA it's mostly about the therapy and not meds anyway.

Hippotherapy is all the rage and people know it is pricey so that is a plus. I'd definitely do some pro-bono cases if you can as in my experience the effect it can have on an underprivileged kiddo is amazing. Good luck you have the makings of a successful boutique practice.

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Thanks for your thoughtful response! More than likely, my fear of criticism is actually fear of my own criticism - the fact that I wanted to make money with my job was something I couldn't say out loud for a long time!

Lots of things you mentioned are helpful. I hadn't heard of the term "boutique practice" but that has led me to much more info on this board and on the internet at large.

I can see how it makes financial sense to let the therapists do therapy. And honestly, they have more experience with it than I. But I wonder if I'll find myself being bored with most of my patients. My day now seems 85% filled with "here's some prozac...here's some adderall". Whereas before in the IOP, it was more "here's some depakote, zyprexa, psych testing, clinical systems meeting, neuropsych testing..." on just one patient. I certainly don't miss the stress that came with that, but I am working to figure out a balance and how to enjoy this new population.

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Just as a data point, I know a psychologist who is getting $350 an hour in Silicon Valley. If you can build a "niche" boutique practice with some affluent clients, you should be able to get a good hourly rate. Your horse angle is definitely interesting. That will also allow you to take some pro bono clients.

Good luck.

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Thanks, ShibaOwner. Nice to hear some positive, real-world data.

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You live in an affluent area, and you may be able to move in this direction. It will still be a lot of prozac and adderall, haha, the wealthy don't usually need depakote for some reason.

I make quite good money doing what I do, I am not ashamed of that at all, nor should you be.

I would start on Saturdays, keep a regular job, and try to grow it from there.

It is very much a long term plan. I don't know the market where you are, nor your competition.

If there are such lucrative practices in your area, I would look into their business. I might even book an appointment!

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Specializes in Psychiatric and Mental Health NP (PMHNP).

I hope the OP keeps us apprised of her progress. I was thinking that in addition to , she may need additional insurance for horse-inflicted injuries, depending on how the horses are used. I know a lot of horse people and they have all been bitten, kicked, and/or fallen off horses. Best wishes.

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OldMa - I replied to your own thread before I saw your reply to mine. A lot of what I wrote in yours would fit nicely as a reply to you here (and some redundant info as well).

Fullglass - Will do! And I have considered that horse insurance as well! Nobody will be riding atop the horse, so *hopefully* it won't cost a fortune.

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Specializes in Therapeutic Riding Instructor.

Love that you want to incorporate horses!

I am a Therapeutic Riding Instructor certified through Professional Association of Therapeutic Horsemanship International (PATH Intl). There are 2 models that can be followed for this - PATH Intl does Equine Facilitated Psychotherapy; another organization called Equine Assisted Growth And Learning Association (EAGALA) uses another model. Both models use an equine, an equine specialist, and a psychotherapist/psychiatrist in sessions to help their clients reach their goals, although the methodology differs between the two organizations. Google local riding facilities that offer therapeutic horsemanship, ask which model they use, and volunteer or intern so you can see which model suits you better.

As for your horse, a great therapy horse is not necessarily an expensive horse. Some great therapy horses are rescues and free-leases. If you want to incorporate riding in your program, you must assess your equine-partner needs based on the rider's physicality - can your equine carry the weight? Does your rider need a choppy gait for more "arousal," or a smooth gait? Do you need a narrow horse for a client with high tone, or a wide horse for a client with poor trunk control? But the biggest factor in choosing an equine partner, for riding or ground work, is their temperament.

Many Therapeutic Horsemanship facilities would LOVE to incorporate more EFP in their programs. You do not have to go it alone as a private practice. And their horses are already trained for this kind of work.

There are thousands of facilities across the country who offer these kinds of programs - find one near you and get involved!

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Specializes in Vascular Neurology and Neurocritical Care.

Not to be a Debbie downer here, but with the horse idea, definitely consider the liability of someone falling off a horse or getting injured. Mental health is not my specialty, but from what I remember some of these patients don't exactly relate to animals well, and if they spook any of the animals it seems that they might get kicked or otherwise injured. I would also be willing to bet that your standard malpractice policy from NSO probably would not cover something related to the addition of horses to your practice. Would you have someone who is a certified horse trainer teach clients how to properly ride the horse? Will there be a scenario in a malpractice case against you that you didn't provide the proper horse riding training and/or aren't certified to do that?

This sounds like a cool idea, but I'd think it through very carefully before diving into that.

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