Having a difficult time setting my fees as a new professional

Post date: 2021-06-15 10:02:06
Views: 81
I am a newly minted psychiatrist in a major city with a large market for cash-pay mental health services. I can't figure out how to set my fees for private practice and actually go through with it because market rate seems so exorbitant.

I know the market rates for the full fees in my area are in the neighborhood of $350-800 for an intake and $250-500 for a follow-up appointment by a MD psychiatrist. The vast majority of MD psychiatrists here do not accept insurance, and the handful that do are in group practices that can likely negotiate higher rates with insurance panels, as opposed to solo practice. The recent graduates from my program, considered among the best programs in the country, all charge market rate and, based on conversations I've had from reaching out to alumni, have absolutely no problem filling their practices with cash-paying patients.

I just can't bring myself to charge that much. Like, I can't even tell my patients that this is my fee with a straight face because it feels like an insane amount to charge for healthcare. The people in my personal life who I discussed this with, who are not mental health providers but are immigrants and/or POC, imagine that the people willing to pay these rates must be really miserable in their lives, to the point of desperation, to pony up so much cash for treatments that often take months, if not years, to take effect, and are sometimes unsuccessful. I've talked to other physician (non-psychiatrist) friends who have similar backgrounds as I do, who have point blank told me that they think that these rates are unethical. I know my own family members would not be able to afford this and would also likely not value mental healthcare to the extent that they would pay these rates- this is common among immigrant and POC communities.

In the process of learning how to set up a private practice, I realize there are actually a number of overhead costs I never thought of as a patient - things like paying for supervision, office rent + equipment, malpractice, liability insurance, licenses/DEA, CME, EMR, HIPAA-compliant phone and fax lines, paying an attorney and accountant, covering my admin time, covering for the patients who may shirk their bill, saving for my own retirement and benefits, etc. - not to mention all the time, effort, and expense I've put into training. Intellectually, I understand why I need to charge this much. Clinically, I also understand that it is important for both me and my patients to value my time and work and to take care of my own needs, and part of that involves maintaining the therapeutic frame by charging a fair price for my services. But I'm still like, what? Who in the world would pay that much? I wouldn't pay even a fraction of that - I remember back when my copay was $30 as a student, and it already felt like so much money - like, a week's worth of groceries. I've always gone through insurance to seek out my own mental healthcare (my program had a discounted fee arrangement for trainees) so I have not had the personal experience of paying these rates for mental healthcare. The only possibly redeeming thing is that I have had a year of therapy that I found to be invaluable and I know that if I could pay now to have a similarly meaningful and life-changing experience, I would. (Am I really offering that kind of service to people, though? I feel like finding a good psychiatrist can be a bit hit or miss, and a lot to do with finding a good fit.)

I am in an area with many young adults - which is a great stage in life to get mental healthcare - and it almost feels unfair to charge that much because I guess I perceive and have personally experienced (or am actively experiencing) that stage in life as a financially lean time. On the other hand, I also know that many young adults in my city have very high-paying jobs or wealthy parents - and maybe this is my own baggage from not growing up with that background. I mean, it's also their money, so they can choose how they want to use it, and maybe I'm overthinking all of this and being paternalistic.

I can already see myself sliding my fee for everyone who walks into my office and I know I can't do that. What do I need to do to get on board with valuing myself, my time, and my craft? Has anybody who works as a mental health professional in a similar type of market also successfully made this leap?
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