John E. Dunne, M.D.

In a survey of psychiatrists by the APA as recently as 1996, 50% indicated that they spent the majority of their time in solo or group private practice. Another 30% said that they spent at least some time seeing patients on a private, fee-for-service basis. So why is private practice so appealing to so many?

Probably the most attractive part of private practice is the sense of personal control over your professional life. Since the need for child and adolescent psychiatrists is so strong, you have the luxury of living anywhere you choose. An urban setting that has several training programs, such as Boston, may be a more difficult place to start a private practice because there tend to be so many child psychiatrists already in practice. However, there are usually more public sector jobs to support you while you are getting started. You also have control over your hours, an important consideration for single parents and those with health problems. And you have control over your finances, allowing you to manage your office in any way you want (HIPPA regulations not withstanding). If you want to collaborate with colleagues, you have the freedom to choose and to structure those relationships to fit your needs.

Financial motivation is probably strong for many who enter private practice. Moonlighting with private pay patients is an easy way to supplement income. The flexibility of private practice allows individuals the ability to pursue opportunities as they arise. There are many niches that larger, established clinics or institutions won’t be able to fill. Individuals and small groups, by their willingness to be available, can readily respond to community needs. By pursuing the most lucrative opportunities, it is possible to earn more than in most other professional positions.

However, most entering child and adolescent psychiatry are not motivated primarily by financial consideration. We are interested in helping children and their families and financial concerns are secondary, as long as we can live comfortably (and pay off those heavy student loans). Private practice allows you the opportunity to become a valued asset within your community, for you to take on many roles, depending on your own skills and personal inclinations. You can develop special areas of expertise, develop special services, consult to pediatricians, schools and others who see disturbed children, or become active in community affairs as a spokesperson and advocate for children’s mental health. You have the freedom to create a rich and rewarding professional life.

So what is the downside? All this freedom and choice is not without a cost. The cost is in the extra time, effort and money required to develop and manage your own practice. It requires a lot of front end effort, a willingness to get out of your office to meet others, and a genuine desire to be helpful in your community, using the skills you have developed. And once you have created a viable practice, it requires sustained effort. Much like doing the laundry, it’s never done. Dr. Steven Grcevich and I wrote a series of six articles on starting a private practice that appeared in the Academy Newsletter which you might find helpful. We also put on workshops at the Academy’s annual meetings to help you get started and to learn how to manage a private practice.