Licensed Social Worker Monica Mehalshick in Philadelphia wrote in with the following dilemma . . .
I am an LSW in the state of Pennsylvania and for the last seven years, I’ve been working at an inpatient facility for substance abuse treatment.
I recently have been attempting to find some other ways to continue within the field, and was offered a position in a private practice. I was informed that upon joining the practice, the director would be able to assist with marketing and finding the clients, and they have an officer manager to continue the billing,etc, but that I would just be doing the therapy which is a great opportunity!
A few months back, I had been offered a similar position in a practice, however, the practice just consisted of a psychiatrist and after obtaining my IP, and we continued the process with insurance, I was informed that since I have my LSW, not my LCSW, that they could not bill the insurance.
I have a follow up interview with the more recent position to meet the other therapists within the practice, and at this time, I know that this is a great opportunity, however, I don’t know much about going into a private practice and my concern is that I will need to take the time to build up a clientele in order to be financially compensated (with my current job it is salaried). However, I am unsure of whether I’ll run into this issue with just being an LSW in a private practice. I’m not sure if this helps, however, the director is an LPC.
Any suggestions or information would be super helpful!
Monica”
Monica’s situation is common. As mental health professionals gain their sea legs in the field, they often get the itch to move on into other settings or into private practice. I did that. And, I was not prepared.
Before you decide to turn in your resignation, give up your salary, your benefits, the free supervision and professional development that often come with the lower pay of agency jobs, if your goal is private practice, you have some things to do.
Unless you have the financial backing of another income, you need to save up a pile of money to pay your expenses to live on. It is not uncommon to spend more money – a lot more money – than you earn in the first year or two in private practice. Plan on it. If I’m wrong, I’m happy for you. But if I’m right, you can drop in here and thank me!
If someone approaches you and invites you to join their practice, then I’m assuming they think that you have really strong clinical skills and will be an asset to the practice and it’s reputation. It doesn’t really mean anything beyond that. Don’t assume that they will keep your appointment book full – even if they have someone on payroll to market the practice. You need to ask questions and get the answers in writing – specifically “How many clients will you guarantee / week?” “What happens if you don’t produce them or they don’t show?” And, by the way – how do you expect to get paid then?
Don’t assume that just because there is a billing person on payroll that their services will be free or available to you. Nor should you assume that their billing is correct. You – not the billing person – are ultimately responsible for those bills. Again . . . ask questions and get answers in writing.
None of the insurance companies that I am aware of will reimburse a mental health professional unless they hold a terminal degree and clinical license. That degree and license vary from company to company and state to state here in the USA. You need to do your research and find out what that means about you and your particular discipline in your particular geographic area. Call each company that you are interested in being a provider for and ask for “Provider Relations.” That is the department that can provide accurate information to you about their requirements for reimbursement. Get the info in writing.
I speak from experience when I say you will not hang out your shingle and find that the masses come your way. You will need to build in time to build up a private practice. Thriving as an entrepreneur is not contingent solely upon your clinical skills. Success is not so much about whether you are on managed care panels or whether you hold certain credentials as it is about the business of private practice.
As you begin to think about being in private practice . . . you need a plan – one that helps you map out how you are going to help clients find you and how you are going to keep them. That’s really what I do – help you figure that out.
If you like to get your information on line, feel free to prowl around this website and others to learn all that you can.
If you prefer to get your information from books or in classes, go for it! That works well, too,
If you need one on one support from a consultant or coach or mentor, you can hire me to help you map out that strategy for growing your practice.
Or, if you like working with a small group of like-minded therapists who are growing their practices together and supporting each other in the process, I can help you with that, too.
Whatever your learning mode it, know that there are lots of right ways to build a practice into a strong and resilient business. Just know that above all else, you will do best by taking the time to create a plan that is unique to you and your circumstances, that reflects your values and desires, and is chunked into small enough do-able steps that build your courage and your confidence along the way. What else can you guys think of that might be helpful to Monica and others who are getting ready for private practice?
I just started my private practice. Yesterday was my first day at the office. Very exciting! No, I did not have clients, but my friends came over, it was really nice support. This is my new web site. I would appreciate feedback from colleagues. Thank you.
Hi, Ethel! Thanks so much for dropping in here to share the good news! How exciting for you! Here are links to two posts to help you on your way:
How a Tiny Picture of You Can Help Drive Traffic to Your Website or Blog
Twiddling Your Thumbs? What to Do While Waiting for Your Clients
Hello Monica,
Everything that Tamara said is correct. I had been working in the human services field for over 20 years and finally took the classes I needed and got licensed for my state (Maryland). Initially, I took a position with a counseling center that took 44% of the fees I brought in, in exchange for space, billing services, advertisements,and supervision. It was very slow going, I had to do my own credentialling (which is detail oriented and time consuming), their billing was very limited, and I had to share the space with 3 other counselors. The referrals came very slow too, and I didn’t like the pricing the owner requested that I do for the group I wanted to run. The supervision was a problem for me too – we just had a different approach to counseling. I left the practice and started my own, business is booming (I had a lot more of my own contacts and networks that I gave myself credit for), I pay for my own supervision with someone who has been in the field a long time and I have great regard for. I am now looking for space to expand my practice. I did most of my own billing (office ally.com) but have recently hired a 3rd party billing company to help with more difficult insurance companies. Initially, when I was in the information gathering stage I used websites like Tamara’s, and LinkedIn has groups you can join – practitioners offer lots of info to help others out. I also found that the ACA magazine and website has great information. I learned a lot about myself at the counseling center even thought it wasn’t the place for me. So mistakes can be very helpful. It gave me incentive, inspiration, and launched an entreprenuerial spirit that pushes me forward. My success lies in intiative and reaching out – I did mailings and free presentations at schools – to get my name out there. I also offered group classes at reasonable rates. Good Luck – there is no one recipe for success. You will find your way! Keep reaching out, asking questions, and listen to the wisdom of others, as well as to your own intuition. Thanks Tamara for your wonderful resourceful website!
Best Wishes,
Vivian
Hi, Vivian! Welcome back! Thanks so much for taking time to share your experiences. The information and stories mean so much more when they come from you guys rather than just me. I know it takes time . . . and sometimes it takes courage to make the effort and share your journey. I appreciate you, Vivian, supporting Monica (and others) by sharing.
By the way, you can get a tiny little picture of you to show up by your comments (on my blog and others). Here’s how http://www.allthingsprivatepractice.com/how-a-tiny-picture-of-you-can-help-drive-traffic-to-your-website-or-blog/.
As usual, Tamara, you’ve given Monica honest, valuable information. Being in private practice is very rewarding for me yet it’s one of the most challenging things I’ve ever done.
My advice to Monica is to determine your strengths and weaknesses in regard to the business side of private practice. Seek help from more experienced professionals to help you build up your weaknesses.
Good morning, Pam, and thank you for making this point about knowing your strengths and weaknesses. None of us do all things well. (You can check out my post last week – The Courage to Feel Your Fear and Do It Anyway – to see my own challenges!) By learning what those are and learning to articulate them, we are better able to leverage our strengths and compensate for our weaknesses . . . and both of those are critical in planning for and building our private practices.
Tamara,
I reviewed the information you passed along here on planning for a professional will. Excellent information, and something every therapist really needs to take into consideration. Bravo for providing such worthwhile info!
Nancie Kohlenberger, LMFT
Nancie, thanks so much for letting me know that I’m on target here with my content! I hope you’ll feel free to add to posts anything that you think I might have left out or forgotten, too. I’m looking forward to learning from you and sharing what I know, too.
Hi Monica,
Congratulations on pursuing a private practice! I can echo what has already been said here by saying that private practice is both an exciting and anxiety producing endeavor! One of the ways I knew it was the right direction for me to move in was the excitement I felt about the challenge of the business side of private practice! It was a steep learning curve and I loved every minute of it . . . I also love that I am constantly growing, learning, and stretching myself!
One of the things that I did from the beginning was map out a very clear vision of what I wanted my business to stand for in terms of values, etc. and potentially grow into (i.e. areas of specialty, interns, etc.). I utilized numerous resources to do this including blogs, books, workshops, and classes. One of the most helpful books to me when I was conceptualizing my private practice was Lynn Grodski’s “Building Your Ideal Private Practice.” I also had to let go of my tendency towards perfectionism and realize that it is a dynamic process and it’s okay if you don’t have everything perfect from the get go. No matter how much time you spend researching, preparing and planning; you will change things as you go along and that’s okay! In fact, I think it’s necessary . . .
Finally, I can’t speak enough to the importance of building multiple systems of support. I found one of the most challenging aspects of private practice to be the isolation. I missed having colleagues and supervisors in the same office and being able to pop over and discuss a case or laugh over lunch. Recently, I was able to move into an office suite with 4 other therapists and I have that again but for the first year and a half of private practice, I was alone in my office and there were days that I only talked to clients. So, I joined peer consultation groups, had multiple supervision relationships (group and individual), volunteered for boards and panels, and attended networking events. I took any opportunity that came my way to get involved in areas I was passionate about and build relationships. From a business side of things, this has really helped me build a caseload as well because people generally refer to people they know.
The one last thing I’ll say is don’t hesitate to reach out! I have found that my colleagues and peers are happy to share resources, forms, policies, ideas, etc. There is no need to re-invent the wheel. I believe if we all work from a place of abundance and take a collaborative stance, everyone will benefit – including our clients!
Warmly,
Catherine
Catherine, I knew I liked you! Yes-siree! Every bit of that is great advice for any therapist planning on private practice. And, if you don’t have a peer consultation group to join, start one yourself! Here’s how . . . .
I am also in PA and in process of credential king to start my practice. Most insurances I have been forking with will not credential an LSW. I agree you need more info.
Have you considered doing it in smaller steps, ie try working for the practice 1-2 night a week and test the fit, rate of referrals?
Hi, Maria! Thanks for dropping in today to chat. You make an excellent suggestion – baby steps are a really smart way to begin a private practice. One of the reasons that I struggled so much (and just about starved to death) the first time I went into private practice is because I just turned in my resignation at the psych hospital I was working with, hung out my shingle, and thought the masses would come! They did not!
Had I been wiser and more practical, I would have realized that I knew nothing about building a business, very little about marketing, and needed to dip my big toe into the water slowly to check it out, make the mistakes that neophytes typically make, and learn before biting off five days / week!
Maria, what are you doing now? And, where are you in private practice?
I open my doors in Harrisburg, PA on June 1!
Maria! Congrats to you!!! I know you must be excited! Please do drop back in and let us know about your practice, where we can find you online, and how we can support you as you get ready to open your doors!
I’m looking forward to having your fresh voice here chatting away!
I began planning to go into private practice about 2-3 years ago, I went between joining one group, then tried to start my own office and finally landed a nice group called Eagles Landing Christian Counseling Center about a year and a half ago. I read everything that I could about insurance vs. fee only, and also business planning and marketing. Anyway, I spent a lot of time planning (trying to leave my agency job) and so I felt prepared when I finally made the jump. I will say I did not to the practical thing and keep my agency job while I build my clientele at the new place like I planned due to some difficult circumstances there, but I was able to find some odd jobs and had some savings. A year and a half later I have a pretty full load, steady referrals, and I like that I’m in a group. We collaborate, there’s billing person, and tons of support. Maybe one day I’ll go on my own completely but for right now this is the best practice setting for me and I am happy with it.
Jill, thanks so much for dropping in here to share your experience with us. You reference several things that are worth repeating here: Starting off in an agency (even if it’s not ideal) is a very smart choice. In fact, I think I’ll reach out to you back channel about an idea I have for a guest post on this:). Planning for 2-3 years – actually doing your homework ahead of time on insurance and fee structures, business and marketing – definitely gives you a head start on your colleagues who bounce right out of school with no forethought and simply hang their shingles out. And, landing in a group that is a good fit for you with lots of support and perks is such a smart path to take, too!
Jumping from an agency job with a steady income to just private practice can be a deadly move for many therapists. (It almost was for me.) But, fortunately, you managed to weave together a safety net of some odd jobs and some savings, too. Good for you!
I appreciate you sharing your journey with us here. Otherwise, those new and soon-to-be in private practice would have very little to compare their own experience to.
Tamara I certainly did not plan to jump straight out of an agency job, I really planned to go into private practice more gradually (you know like a practical smart person) but the agency I worked for at the time was going through some issues and it was time to get out. So while it was a dangerous and scary move, I felt free to pursue other things. Some of the issues I went through prompted my new blog, http://www.jillosbornelpc.com. I would love to hear your idea for guest posting.
Thank you all so much for all of your comments. I have been reading them and wondering if going through insurance companies is the only way to fill up a new private practice. I just started. Yes, this is my second week! I do have however a web site I worked really hard at:
http://www.therelationshipclinic.net
While I find myself to be a great clinician, it is indeed the marketing side of being in business solo
that I find it challenging. So again, my question: To go through insurances or not?
Thank you,
Ethel
Ahhhh, Ethel! You are asking the million dollar question and I’m sure you’ll get lots of varied opinions here. Here’s one . . . .I thought when I went into private practice that it was a given that therapists work directly with managed care. I did that for at least 5-7 years before I realized I was starting to hate my job – way too much paperwork, way too little clinical work for all my efforts to stay afloat.
Eventually, I resigned from every managed care panel I was on and decided to no longer file client’s insurance for them. Those were the smartest decisions I’ve ever made in my practice. So, no . . . you do not have to work directly with managed care in order to thrive in private practice.
Here are some posts that I’ve written related to insurance and managed care. Take some time to prowl through those. Read about others’ experiences (I’m sure they’ll be dropping in to chat soon). And, then make up your own mind based on what is in your best interest. The good news is that you can change your mind down the road.
The one cautionary note I would offer is to not pay someone else to pursue the application process of getting you on to managed care panels. Yes, it can be a headache but it’s not rocket science. There are no secret passwords or shortcuts. You can jump through the hoops yourself. Just decide first of all if it’s really what you want to do.
Oh my goodness, I just read your link to say “insurance and mangled care”. Yes, it’s late, but that just struck me as funny. As a registered intern (in Florida), I am beginning to come up with a plan for private practice. I have about another year or so as an intern and am trying to use my time wisely. I selected a very knowledgeable clinical supervisor, am developing a vision and mission for my practice, am beginning to develop a website and blog, joined a peer review group, and am increasing my networking through LinkedIn and beyond. I’m setting limits so I’m not working more than 40 hours per week at my agency job so maybe, just maybe, I can pick up a private practice client or two on the weekends. I’ve taken the “empty shelf” challenge and have emptied one of my bookshelves to fill it with books I read (and finish) this year. My task this week is to make a list of books I want to read this year that relate to clinical skills (I want to expand past what I already know, which is Family Preservation) and building a successful practice. As you can see, I’m getting excited about this, and I’m gleaning everything I can from your site to help me plan. 🙂
Michelle White! It’s so nice to meet you! You just made my day! It sounds like you are doing everything right from choosing a strong supervisor right on through to actually planning for your private practice! I hope you’ll stay in touch and let me know if / how I can support you on your journey! You’ll find the community here to be chocked full of supportive and optimistic therapists at all levels and nary a downer in the bunch!
Who knows, Michelle . . . I’m always looking for an excuse to come to Florida and I’ve still got some of my 2014 schedule open for speaking engagements! Let me know if there’s a group that wants me to head down your way. Happy to talk private practice all day long!
Please don’t be a stranger here. Every voice counts!
Tamara, thank you for the warm welcome. I will certainly stick around, I have so much to learn. You are always welcome to visit the Sunshine State, even when it’s frigid, like today. So many of us are hungry for knowledge on how to build a thriving practice.
🙂 Thanks, Michelle! I how to get down to Florida for some private consulting gigs with therapists even if a speaking gig doesn’t materialize this year!
Hi there guys! Thanks so much for the feedback – what I decided to do was to try this private practice one night a week… that way I still have time to commit to my full time job at an agency, but attempt to “get my feet wet” and determine if private practice is the way to go, not only for me personally, but professionally. The practice has a billing person and the referrals are already made, so my job is basically to come in and provide therapy for the referrals. I do think that just attempting to try it once a week and giving it a shot — it’s worth a try, however, that way if it’s not for me, then I’m still able to have a full-time to pay the bills and support my family and my child. On the other hand, if I do find that it’s something that I enjoy, then I have the opportunity to transition SLOWLY..
Hey, Monica! Thanks so much for dropping back in to let us know what you’ve decided to do. I think you’ve made a great choice balancing the risk with your desire to do something different, too! There’s definitely not a one size fits all solution to any of this.
Hey, feel free to drop back in here to let folks know who your ideal client is and how we can refer to you if you aren’t as busy as you would like to be! I look forward to networking with you!
(By the way – here’s How a Tiny Picture of You Can Help Drive Traffic to Your Website. It’s easy and it’s free!)
Monica, I can’t remember if I mentioned it but you can get a gravatar – a little image of you to pop up when you comment here or elsewhere. You can find really simple instructions to show you how.
I have spent an entire morning reading this site and learned so much from you Tamara and all people who comment on your blog. I just graduated with my masts in marriage and family therapy, and I decided not to go the traditional and save route and go the empowering private practice route. I do have a job not related to psychotherapy( family business) and doing my internship in residence home, I realized that I do need to have my own private practice. I got myself tons of books and reading different materials and really open to different ideas to start a thriving practice. I wrote a plan and still have a lot of things to accomplish before I start the practice. I just wanted to let you know that I am learning a lot from you and I will keep you posted on my journey. I am also in Colorado, so all therapists in this beautiful sunny state I am looking forward to meet you and to get to know you and to refer clients to you!
Hi, Nelly! Welcome to Private Practice from the Inside Out! Thanks so much for dropping in and introducing yourself! It’s so much more fun hanging out here when you take time to join the conversations! Where did you learn about my blog?
Where are you geographically? I look forward to networking with you, too!
Thank you so much Tamara, for such a warm welcome. I found you via google search as I was looking for ways to start a private practice. I live in Centennial,CO very close to you. I am just starting on my journey and I am very excited about each step of the way. I was born in republic of Georgia, former USSR and I speak Russian and Hebrew in addition to English. I am an eternal student of life and I enjoy the process of learning about everything in life and now I immersed myself into learning about private practice and starting my licensure process. Also wanted to ask you if you are still available for supervision, as I am in search for an inspiring and knowledgable supervisor and you definitely get the cake for both! I am looking forward to get to know you and everyone in your wonderful community! Hope you enjoy your Sunday and so looking forward to talk with you!
Hmmm. How odd. I replied to your inquiry about supervision but see that it didn’t actually post. Let’s try this again! I do provide clinical supervision to counselors pursuing licensure here. Where are you in school and when do you graduate? Happy to chat about this and provide referrals for my supervision, too! Just know that clinical supervision really is about the clinical piece of our work and not the business building end of it. Happy to share what I know on both ends but you’ll only get to count the clinical end of our discussions toward your clinical supervision. (I’m a bit rigid about it:)
Thank you so much Tamara, for everything. I graduated in November 2012 from University of Phoenix with Masters in counseling in Marriage and Family therapy. I am looking into to start my private practice around September/October of this year, still have a lot to do before that, and I do enjoy each moment and it is a very fascinating journey. I do understand that you don’t mix clinical supervision with practice consulting, and I think that is the way I want to do it, because I want to make sure I learn as much as I possibly can so I can offer my clients the best me! I came up with a business name for my practice and now trying to narrow it down, that is exciting! Now waiting for Dora approval to start accruing my hours, looking for sublease, my to do list is huge, but I am having fun with process… Plus I do wedding planning, as I am getting married in October and have a full time job… But I enjoy the insanity for now! Hope you have a wonderful day and your blog is my favorite and I learn so much from and your readers and so grateful to you for your warm welcome and helping me on this journey!
🙂 Happy to have you here, Nelly! Let me know when you start interviewing for clinical supervisors! I’m happy to chat and toss my hat into the ring. And, happy to provide references, too! In the mean time, you may want to check out some of the info here on clinical supervision.
Nelly, I thought you might want to know how to set up a little gravatar so that when you comment here and elsewhere you will have a little image of you pop up. Here are instructions on how to do that – it’s really easy!
I have a question. I have an office in Illinois and it is on the border of Wisconsin. I am licensed in both states however, my office is in Illinois. Will insurance companies allow me to see clients from Wisconsin in Illinois or do I need another office?
Hi, Linda, and welcome to Private Practice from the Inside Out! The short answer is . . . I don’t know. And, the more accurate answer is that no one else other than each of the individual insurance companies is going to be able to give you that answer. Of course, if when you applied to get on those managed care panels, you entered both addresses in your applications AND your subsequent contracts with them did not prohibit working at either address, you are covered. However, if you were granted permission via contract to work at one site and then subsequently added a second site, you will need to notify each company and get permission from them in writing to see clients at both sites. I suspect, but do not know, that this will be a simple thing to get approved. The important thing is that you actually go through the steps to get the permission.
I hope you will drop back in to let us know how this all works out for you, Linda. And, should you be interested, I would welcome a guest post from you letting us all know what you have learned. Here’s a link to my guest posting guidelines.
Any ideas on how to get on Aetna? I applied and received a response the the network is full in my area. I know the school district is switching to Aetna in August 2014. Should I reapply then? Im getting discouraged a d wondering what an agency can do for me I cant. They are awfully expensive and I havent made a profit yet.
Hi, Christina, and welcome to Private Practice from the Inside Out! I absolutely do know How to Get on Insurance Panels as a Preferred Provider! Check out this series and see if you don’t find a few new tips.