Emma K- Viglucci

What Do You Love About Private Practice?

Ask me about my private practice and I light up. I love it. I just spent the last day and a half furnishing and decorating an additional office location in a neighboring city. I'm excited to be able to expand the reach of my practice and help clients in other geographic locations. There is such a satisfaction in feeling fully self-expressed professionally and to make a difference in the lives of my clients and my colleagues. My passion for building a private practice is why I asked Dr. John Grohol, CEO of PsychCentral.com if I could start this blog. I can't imagine being happier with a work situation and I want to help you develop the tools to feel the same way about your practice. I asked several successful private practice therapists the question, "What do you love about being in private practice?" I wanted to share their answers with you to inspire those of you who are considering going into private practice to do it! If you're unhappy with your practice, I hope you'll draw from these successful private practice experiences to create a practice that you love.

It's not "work"

Lynn Krown MA, MFT:

 

When you do something you are passionate about it's not work. I intend to work well into old age. The more life experience and mindfulness I have, the more wisdom I have to offer. I'm grateful to feel so fulfilled and alive as a psychotherapist age 70 this month.

Accurately represents who I am

Julie Jeske, M.S.:

I love it because it is mine. It is an accurate representation of who I am and the work I do. I truly love what I do and having a private practice gives me the freedom to really design and build my ideal practice. I can work when I want...in fact this summer I spent 5 weeks in Paris. I don't know if I could have done that if I didn't have my own practice.

I look forward to work

Gabby Acord, LCSW:

I look forward to my work and the days fly by. I don't get insurance benefits or paid time off, but I also earn 50% more than I would working full-time for the local University hospital and they pay very well. I feel good that my children know that my work is to help people and they don't resent the time away.

I'm my own boss

Amy Luster, M.A., LMFT:

I am passionate about maintaining a private practice as it grants me the ability to participate in the way that best suits me. I am an active parent to four elementary school aged children and I am able to schedule clients in a way that permits me to be present for my children. As they grow older and more independent, I am able to increase the amount of hours I can see clients in my private practice. I am not beholden to a specific way of working with each client, but rather, I'm able to respond to the needs of each individual, couple or family.

Allows me to refine my specialty

Geoff Steurer, MS, LMFT:

Private practice allows me to refine my specialty in working with marriages impacted by sexual betrayal. When I was working in an agency setting, I was required to see whatever cases walked through the door. So, in any given day I could end up working with children, teens, couples, elderly, and families. Even though I certainly enjoy the variety that comes from working in an agency setting, there is something deeply gratifying knowing that I'm developing a skill set that comes from working with the same types of cases day after day. I love knowing for certain that I can make a difference in the lives of the clients sitting across from me in my office.

I set the rules

Esther Kane, MSW:

I set the rules and love it! I’m independent and it suits my personality. I love the flexibility- going away whenever I choose and working hours I prefer. I get a highly-motivated client-base who are ready and willing to do the work. I own my own office overlooking the ocean and it’s like my second home.

It adapts to my changing lifestyle

Shannon Purtell MA, LPC:

In the last 3 years I have gotten married, and had 2 children. Private practice has allowed me to adapt to my changing lifestyle. It worked great when I was single and could work evenings/weekends, etc. and it works great now when I need to be home evenings and weekends to be with my family. Private practice affords me the opportunity to build a company that makes a difference in the lives of our clients, and provide a healthy work environment for my associates and interns.

It's a thrill to see people change

Eileen Kennedy-Moore, PhD:

There is no greater thrill than seeing people make real change for the better in their lives and being part of that change process. I'm grateful for the opportunity to do work I love, as my own boss, with hours that mesh with my family needs.

 

Meaningful connection with others

Loren A Olson MD, who is in the process of retiring from his psychiatry practice:

I have experienced the joy of connecting with people in the most emotionally intimate ways. I *know *them deeply and meaningfully. And although I've always maintained professional boundaries, I find that they know me, too. And so I grieve the loss of these relationships even while knowing that I am responsible for my own happiness. And as I retire I will find new ways to find pleasure in my life, but I also look back with a sense of satisfaction about having chosen such a meaningful profession.

Do you love being in private practice? Tell me about it! If you're not happy with your practice, what would you like to change?

If you have any topics you'd like me to write about, or specific questions for me comment below, ask me on Twitter @Julie_Hanks, or contact me directly here.

What I Wish I'd Known Before Starting A Private Practice

If you're considering going into private practice, it's always smart to talk to other clinicians who have been there. When I opened my practice years ago, I had very little business experience. Luckily, I did a few things right that allowed me to be profitable (and it didn't hurt to be married to a CPA). Over time, I learned that I have a knack for marketing and networking that has allowed my practice to continue to grow, even during a recession. Few private practitioners are armed with small business skills when they venture into private practice. According the U.S. Small Business Administration, around 50% of new businesses will close their doors within 5 years.  The realities of making a profit and running a successful private practice can be discouraging and exhausting. If you're considering opening a practice, I think you'll enjoy several seasoned practitioners answer the question,"What do you wish you'd know before starting your private practice?

Private practice is a business

Like most of therapists, Emma K. Viglucci, CFT, LMFT, CIT  of New York City didn't really understand what it takes to run a business when she opened her practice. "I had some ideas about running a business as both of my parents owned businesses, and about running a practice from assisting run my graduate program's clinic. But, I didn't know the nuts and bolts of being in business."

It's easy to overestimate profit and underestimate the amount of work it takes to start and build a private practice. Psychologist and professor Karen Sherman, Ph.D. says she wished she'd know that working for herself  "wasn't going to be as lucrative" as she thought.

Save for self-employment taxes

When you go into private practice you'll be paying self-employment taxes. If you're used to working for an agency where your taxes are automatically withdrawn each paycheck that catches new practitioners by surprise. Just to give you an idea of how much to save, self-employment taxes for 2011 in the U.S. are around 13% (SBA.gov).  Psychologist Roberta Temes, Ph.D learned about taxes the hard way. "My first year I did not diligently deposit half my fees into a bank account earmarked for taxes. That was a learning experience."

Understand managed care

Texas counselor Shannon Purtell MA, LPC, LPC-S, NCC wishes she'd better understood the world of behavioral health insurance before she opened her doors.

Before entering private practice, I wish that I had truly understood behavioral health insurance and Employee Assistance Programs. Trying to learn the ins and outs of insurance while building a private practice was not only frustrating and time consuming, it was costly. Without completely understanding the industry, I failed to negotiate better rates, was unable to qualify for certain panels, and did not always understand the reimbursement structure. Each company had a different way of handling referrals, authorizations, and reimbursement. Unfortunately, I started in private practice prior to electronic billing and online benefit verification/authorization which has dramatically streamlined the process.

Importance of marketing skills

New York City therapist Diane Spear, LCSW-R wished she'd been better armed with marketing know-how when she opened her doors. Spears says, "You can be a terrific therapist and have a tiny practice if you're not good at marketing. And if you're not naturally good at marketing and networking? Practice! A lot."

Developing a niche and area of expertise is what Clinical Psychologist and author Dr. John Duffy wished he'd known before opening his practice.

I wish I had known the importance of establishing a niche when I started, developing a particular expertise. I found that I work well with families, in particular teens, tweens and their parents. Specializing in this area, I've found that I have a strong knowledge base in this area, and I am more and more confident in my work. As a result, I have a full practice, a waiting list of clients, a popular book, speaking engagements. I am also now considered an expert in a number of media outlets.

Stay on top of billing and record keeping

When you're your own boss it's easy to set some of the less enjoyable and often tedious business details on the back burner. Arizona therapist Lisa Gomez MA, LPC wishes she'd known the importance of staying on top of those tedious administrative tasks. Gomez wishes she had understood the importance of staying "on top of your billing and having good records in regards to accounting."

Practice ebbs and flows

Many private practitioners are surprised by the fluidity of referrals and fluctuating direct care hours. My own practice always dips to the lowest number of referrals and fewest client hours every December. I learned through not getting a paycheck one December to save 10% each month throughout the year to cover the holiday lull.

Portland individual and couples counselor Julie Jeske M.S. has also learned by experience to trust the ebb and flow of her private practice. "I wish I had known more about the way things can fluctuate. Some weeks (or times of year) are really busy and others are slower. The first time things slowed down for me I got really nervous, but it always picks up again," Jeske says.

Solo practice can be isolating

When you practice in a clinic or agency it's easy to take social interaction and peer relationships for granted. There's always someone to grab lunch with or to consult with on difficult cases. For many therapists, the transition to private practice often means a loss of built in professional support system, and the need to actively seek social interaction and professional consultation.

When therapist Amy Luster, M.A., LMFT of Santa Monica, CA opened her practice she found solo practice to be isolating. Luster says, "It would have behooved me to learn about the benefits of participating in a group practice while I was in my graduate program."

Importance of setting boundaries

Maryland therapist Dr. Mary Sidhwani wished she'd know the importance of setting boundaries with clients.

Before I began my practice, I wish I would have created healthier boundaries. I wanted to be available for all my new clients and so returned phone calls and emails 24/7. As time went by, it became increasingly difficult to maintain that with the growing practice. I was able to put healthy boundaries in place, however, it would have been much easier if I had done that initially.

Now it's your turn. What do you wish you'd known before starting a private practice? Please post your comments below.