Dr. Byrne: After completing my residency, I moved to North Carolina and initially started out as a solo practitioner in 2010. Now, 6 years later, my practice has 5 psychiatrists, 3 full-time administrative staff, 2 part-time administrative staff, and we are probably adding some more next year. I also do consulting work.
TCPR: Can you tell us a little about your consulting work?
Dr. Byrne: Sure. I work with local psychiatrists to help them figure out if they want to start a private practice, what kind of model they want for their practice, and then to troubleshoot problems in their practice model.
TCPR: Interesting. I think that most of us consider starting our own practice at some point in our careers. Based on your experience, what is the number one question we should ask ourselves before taking the leap?
Dr. Byrne: If you are doing a private practice, whether it’s solo or group, it’s going to be a small business. So here’s the question: Are you ready to run a small business? You have to be willing to learn how to think like a business person to some degree to do well in the current environment.
TCPR: If the answer is “yes,” then what’s next?
Dr. Byrne: The next question is, “What’s my business model going to be?” The business model drives the clinical work. And whether you take insurance or not will somewhat dictate that model. In my opinion, with the limited number of psychiatrists taking insurance these days, you are going to be in high demand if you do accept it. On the flip side, though, that will push you into a high-volume practice.
TCPR: Why is that?
Dr. Byrne: Because of the way reimbursements work and the administrative overhead required to do the paperwork. If you want to do psychotherapy with your patients, you’re not going to get reimbursed very well, so you are going to be pushed into doing medication management. And that is going to require you to see multiple patients in an hour.
TCPR: I’ve heard from some colleagues they have found the reimbursement with E&M codes to be much greater than it used to be, that it’s much more lucrative now to have an insurance-based practice. Can you speak to that?
Dr. Byrne: Sure. Using E&M codes in combination with therapy codes may allow clinicians to provide therapy to many of their clients at a higher reimbursement than in the past.
TCPR: Do you mind sharing some insight about your practice? Did you ever go the insurance route, or did you start immediately with a private-pay model?
Dr. Byrne: I struggled with that a lot at the beginning. I ended up not going the insurance route. So as a doctor, I am not in network; I am what’s called an out-of-service provider. For my business model, I use what I like to call a high customer service model in that I submit claims electronically for out-of-network patients who have insurance.