In a perfect world, running your own private practice would provide psychologists with a balance of just enough patients with plenty of time for leisure activities, family and educational pursuits as well as a healthy bank account.
While the dream might be possible, there are some aspects of private ownership a practitioner should consider before taking this career step.
Jennifer L. Cantor, Ph.D, a clinical psychologist and psychoanalyst practicing in Wilder, Vermont, said she was an idealistic graduate student, envisioning a career in a public hospital helping the community.
She completed her externships, internship and licensing hours in inner-city hospitals in New York City, and found those experiences immeasurably valuable for building clinical acumen and confidence.
But ultimately, she bristled at the restrictiveness of the hospital setting. After obtaining licensure, she decided to go solo.
Fortunately for Cantor, she had a supportive mentor who provided office space at a reasonable cost as well as professional guidance. She spent 13 years in New York as a private practitioner before moving to the Green Mountain state.
Cantor enjoys the autonomy and flexibility of private practice but warns the inevitable fluctuations in income and relative lack of structure might be difficult for some clinicians to tolerate.
Now more experienced, and with advanced training in psychoanalysis under her belt, she encourages early career psychologists to develop as much expertise as they can before opening a private practice, to strive for depth of knowledge as well as breadth.
She also emphasizes the importance of cultivating relationships with others in the field. can allay the isolation of “Some of the most helpful advice came from former supervisors,” she said, noting relationships with colleagues solo practice.
After working for 14 years in an academic setting, Robert C. Vilas, Ph.D, private practitioner in Brunswick, Maine, decided he had used up his “institutional half life” and needed to move on.
Unlike early career psychologists who go the solo route, Vilas did not face serious risk; he had extensive experience and ready-made clients from Bowdoin College, where he had previously worked.
Setting the Tone
Vilas has found that, unlike working in an institution, whether that might be a school or a hospital, as a private practitioner he can screen clients and accept those who suit his strengths. “I set the tone of my practice. You can’t do that in an agency,” he said.
Before going solo, Vilas urges practitioners to do extensive research regarding location, available resources in the area, and number and type of other private practitioners in the community.
“You should do careful research around the market, see what other psychologists are facing and what referral sources are available,” he said.
Private practitioners need to cultivate referral sources and determine how they will attract clients and advertise their practice.
For those who are leaving an agency, academic position or hospital setting to set up private practice, the loss of benefits can be a challenge.
At Bowdoin, Vilas had health and disability insurance, a retirement fund and other benefits that disappeared when he decided to leave the school.
He recommends creating a plan that takes into account how much money you want to make and then weigh out what you are losing when you leave a corporate or agency job.
Vilas cautioned against taking on too many patients to compensate for lost benefits. “It’s hard to turn down a client. There is anxiety about the wolf at the door,” he said. It’s tempting to accept a large number of patients, but it can have adverse consequences for both you and the client, he warned.
Jonathan Gershon, Ph.D, owner Gershon Psychological Associates LLC in Greenville, Rhode Island is president of the Rhode Island Psychological Association (RIPA).
He is also a clinical assistant professor at Brown University’s Warren Alpert Medical School and did not initially plan to go into private practice.
He first worked with his father who had a group practice and then opened his own in 2006, where he enjoys flexibility in scheduling and the freedom to accept a certain type of client.
Gershon also finds that working for himself enables him to be creative in developing content and programming.
“I helped other psychologists create an early childhood assessment program,” he said.
Psychologists can expect a steep learning curve when opening a private practice, Gershon advised.
He suggested making a to-do list that includes accounting and bookkeeping matters, insurance credentialing issues and appropriate staffing.
Networking is also an important component to consider. “You have to make sure your name is out there,” he said. Attending “meet and greets” and other networking events can help private practitioners keep in touch with other industry professionals.
Early career psychologists might be better joining a group practice to learn the ropes before setting out on their own, Gershon suggested. He noted that there are many aspects of private practice of which a new psychologist might be unaware.
He also strongly urged those who start a private practice to join their state psychological association, which can offer support and mentoring.
Of all the challenges Paul W. Frehner, Psy.D, faced when he opened his private practice in Peterborough, New Hampshire, dependence on insurance companies was the biggest.
“Once you sign the contract, you can’t negotiate rates,” he said. For therapists who offer 60-minute sessions like Frehner, appropriate reimbursement can be difficult to obtain; most insurers only pay for 45-minute sessions.
Frehner is seriously concerned about the future of private practice because of insurance issues. The push toward integrated care and insurance companies’ reluctance to work with private practitioners may herald the end of the solo practitioner, he speculated.
However, he anticipates significant pushback from clients to keep the private practice model alive.
Although owning a private practice might seem like a psychologist’s dream job, this career path holds both perks and pitfalls.
Frehner echoed Gershon’s suggestion that newer psychologists join a group practice to learn about processes and gain some experience before jumping into a solo practice.