Every New Beginning… (Tips for Therapists Considering Private Practice)

This morning I turned in my keys, ID, and laptop, and I signed the form cancelling my benefits. I am fully, 100%, officially self-employed. Want to talk to my boss? Sure, she’s me!

For anyone considering starting their own practice, I thought I would share a few insights from my transition. By the way, let me know if more private practice content would be helpful because I’m happy to write more about it.

Anyway, here are some things I wish I had known before I got started, since they would have made the leap less anxiety-provoking for me.

Your Referral Sources Will Follow You

I personally think it is unethical for an organization to ask therapists to sign non-competes. Clients have the right to make decisions about their care, so if they want to follow their therapist if the therapist changes jobs, they have the right to. Usually a non-compete for a therapist won’t hold up in court, but “I didn’t think they’d enforce it” is not an argument you want to make to the judge, so I recommend refusing to sign one.

That being said, even if your clients do not all come with you, mental health is all about relationships and people. Referral sources keep lists of organizations, sure, but the physicians, teachers, pastors, and agencies that I’ve worked with over the past six years send people to me. And they will keep doing that regardless of the business I’m working for.

Billing Is Hard But Also It’s Actually Not That Hard

This is a quick, unpaid shout out to my electronic health record, Therapy Notes, and their one-click billing system. All I have to do is input each client’s insurance information when I create their chart. After that, I just hit “submit” after each session.

Credentialing is a hassle, but once it is up and running it’s pretty streamlined. I have to chase some payments and follow up on rejections (which is why I would never fault someone for choosing not to take insurance), but honestly it’s nowhere near as complicated as I thought it would be.

You Don’t Have To Do It All At Once

Especially since insurance credentialing can make it take a while for the payments to start. I transitioned over the course of several months – for reference, I turned my keys in November 4, but I told my boss I was leaving in April. Not every organization would give me the kind of support I got in transitioning, but you can start off doing just a little at a time if you need to.

You Get To Have The Best Boss

I used to say I didn’t want to ever work for myself because I didn’t want to work for an asshole, but honestly, calling all the shots about my work and my business is amazing. I am in charge of how my practice is marketed, which insurances I want to drop because the reimbursement is too low, and my entire clinical focus.

I was lucky to have a good amount of freedom at my last job, but now I am fully in control. And no more staff meetings! (No offense if anyone from my old work is reading this.)

Plus, my new boss is so intelligent and good looking.

Private practice is certainly not the right route for everyone. But if you are considering it, know that a lot of my hold ups and reasons I waited so long turned out to be so much less than I imagined!

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. Her clinical interests are varied and include child and adolescent therapy, TF-CBT, rural psychology, telemental health, sexual and domestic violence, psychological assessment, and mental illness prevention. Dr. Marschall presently works in the Child and Adolescent Therapy Clinic at Sioux Falls Psychological Services in Sioux Falls, South Dakota, where she provides individual and family therapy and psychological assessment to children, adolescents, and college students. She also facilitates an art therapy group for adolescents and college students with anxiety and depression. Dr. Amy Marschall is certified in Trauma-Focused Cognitive Behavioral Therapy and Telemental Health.

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