Do any of you in private practice actually do pro bono work?

[R. Matey]

Just curious.

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[PsyDr]

For about 10 years, I did not charge for any hospital services. If you go back and look through all the Friday threads, that should give you an estimate of how much money I gave away.

 

[WisNeuro]

In many states, doing Medicaid neuropsych work is essentially pro bono as it barely covers the cost of the materials, so there is that.

 

[AcronymAllergy]

I've been wanting to, but haven't been able to work in much thus far.

Unless you count reviewing submitted journal articles.

 

[Freud’sMommy]

Not there yet, but what's the upside for doing pro bono in private practice exactly? I could see using it as a marketing tool.

 

[Therapist4Chnge]

I do some pro bono work, mostly on the intervention side of things, not assessment. Currently I have a reduce rate (long-term) patient and a pro bono slot that I fill, as needed.

I learned early on that any pro bono work I do will not involve a 3rd party anything. Medicaid is a nightmare, and so are city/county/state funded groups.

 

[R. Matey]

Not there yet, but what's the upside for doing pro bono in private practice exactly? I could see using it as a marketing tool.

Principle B: Fidelity and Responsibility
Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work. Psychologists uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior, and seek to manage conflicts of interest that could lead to exploitation or harm. Psychologists consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work. They are concerned about the ethical compliance of their colleagues' scientific and professional conduct. Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.

 

[PsyDr]

Not there yet, but what's the upside for doing pro bono in private practice exactly? I could see using it as a marketing tool.

You REALLY don't want to advertise that you do pro bono work. If you do, people will categorize you as the "free care" option. Then they send you all the BS stuff, and send the paying work to someone else.

Most insurance contracts will also limit your ability to do pro bono work.

It is also likely that most psychologists cannot handle the intricacies of indigent people in outpatient settings. Someone is complaining of sleep issues because roaches are biting them in their sleep? Patient has been standing in your parking lot for 4 hrs, and you have to leave? Patient is stressed because they are out of food and money? You don't have the community resources to handle that.

Do charity quietly.

 

[R. Matey]

You REALLY don't want to advertise that you do pro bono work. If you do, people will categorize you as the "free care" option. Then they send you all the BS stuff, and send the paying work to someone else.

That's a really solid point that I never considered.

 

[WisNeuro]

I've provided enough of my time w/o compensation to the field that I'm set until retirement.

 

[ClinicalABA]

Principle B: Fidelity and Responsibility
Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work. Psychologists uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior, and seek to manage conflicts of interest that could lead to exploitation or harm. Psychologists consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work. They are concerned about the ethical compliance of their colleagues' scientific and professional conduct. Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.

Remember that the last sentence there includes things like volunteering (including board membership) for local, regional, national professional organizations, local agency professional advisory boards, community events (e.g. autism walks), giving a free talk a senior or other community center, etc.

If you do choose to provide pro bono treatment/assessment, you need to do so ethically. Even though no money is exchanged, you have the same ethical and clinical obligations to the non paying client. Don't skip the contract that states exactly what you will provide, when you'll do it, and what the client responsibilities are, including the fee you will charge (i.e. 0$). Be very sure not to deprioritize the needs of the pro bono client to prioritize the needs of a paying one- you're state psychology disciplinary board will not accept "yeah but it was a pro bono case" as a defense of any clinical or professional malfeasance on your part.

I can't emphasize enough what @PsyDr said above about checking any insurance contracts you may have to make sure it's allowed. You don't want to set your current going rate at $0.00. I'd also avoid doing pro bono for someone who has insurance that you are paneled with. Apart from not making any sense, you don't want to be seen as party to an attempt to avoid a deductible or copay and get the clientbin trouble. Finally, if you work for anyone other than yourself, make sure they are OK with it.

 

[MiniLop]

To answer the original question: I'm in PP and do one pro bono session a week.

 

[calimich]

No therapy or assessment pro bono work, but I'm part of a 3-person grant writing team for my kids' PTA. We've submitted three grants this academic year, each taking the lead once. I think that counts.

 

[Sanman]

No therapy or assessment pro bono work, but I'm part of a 3-person grant writing team for my kids' PTA. We've submitted three grants this academic year, each taking the lead once. I think that counts.

Your PTA has a grant writing team? Man, PTA has changed. What happened to bake sales?

 

[Sanman]

Principle B: Fidelity and Responsibility
Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work. Psychologists uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior, and seek to manage conflicts of interest that could lead to exploitation or harm. Psychologists consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work. They are concerned about the ethical compliance of their colleagues' scientific and professional conduct. Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.

Funny how one word can invalidate the rest of the sentence.

 

[R. Matey]

Funny how one word can invalidate the rest of the sentence.

I'm pretty sure that's there because the principles aren't enforceable like the standards.

 

[WisNeuro]

Yeah, aspirational. I can only imagine the legal challenges if APA tried to make it an enforceable standard.

 

[Sanman]

I'm pretty sure that's there because the principles aren't enforceable like the standards.

Agreed that it is aspirational. Like spiritual enlightenment. Most people will never get there.

 

[super.ego]

Yes. Pro bono slots, sliding rate slots, and still earn very well.

 

[smalltownpsych]

Yes. Pro bono slots, sliding rate slots, and still earn very well.

Similar, except the pro bono and sliding scale is only for the people working for me that are still getting training and supervised experience. I did some pro bono work when I was starting out but I’m pretty busy with running a business while maintaining revenue.

 

[medium rare]

I currently have 3 pro bono patients and 2 I see at a reduced rate.

 

[texanpsychdoc]

No

 

[Young Grasshoppa]

No

Honest fella

 

[texanpsychdoc]

Honest fella

I worked for free all through grad school - then got exploited during internship so....I paid my dues. I am very fiscally-focused. I run my practice just like any other business, whether they be selling clothes, food, etc. Each time slot has a certain value for me, so I make decisions based on multiple factors with $$ and time being my top two factors. Like Kevin and Mark say on Shark Tank "I don't get out of bed for X amount."

 

[Spydra]

Similar, except the pro bono and sliding scale is only for the people working for me that are still getting training and supervised experience. I did some pro bono work when I was starting out but I’m pretty busy with running a business while maintaining revenue.

Well if you're the one providing the supervision, then you are doing pro bono work in a way. I imagine the profit margins on those training isn't nearly as high as those who can work independently.

 

[msc545]

Any Medicaid work I do is pro bono, since I don't even bother with the billing - simply too much hassle for too little pay.

 

[chicandtoughness]

I have one pro bono slot (I call it a "scholarship" instead of "pro bono") open every 3 months; that patient has the option to "graduate" to sliding scale afterwards. It is time limited and not session limited, so if they miss 4 weeks of sessions they don't get to extend.

 

[msc545]

I have one pro bono slot (I call it a "scholarship" instead of "pro bono") open every 3 months; that patient has the option to "graduate" to sliding scale afterwards. It is time limited and not session limited, so if they miss 4 weeks of sessions they don't get to extend.

Very creative!

 

[R. Matey]

@msc545, I just noticed your signature line and I approve

 

[msc545]

@msc545, I just noticed your signature line and I approve

Thank you! I approve of yours as well.

 

[PsySeeker]

Any Medicaid work I do is pro bono, since I don't even bother with the billing - simply too much hassle for too little pay.

This. Occasionally I have clients who switch into medicaid, and I typically see them for free for a while until they can get back on the exchange. Medicaid is nigh impossible for a solo practitioner. It's so much worse than Medicare, so it doesn't have to be this way, but it is.

 

[Sanman]

This. Occasionally I have clients who switch into medicaid, and I typically see them for free for a while until they can get back on the exchange. Medicaid is nigh impossible for a solo practitioner. It's so much worse than Medicare, so it doesn't have to be this way, but it is.

The public feels bad for "old people" and wants them to have things. No one feels bad for "poor people". I don't imagine it will change any time soon. Bootstraps and all that.

 

[WisNeuro]

The public feels bad for "old people" and wants them to have things. No one feels bad for "poor people". I don't imagine it will change any time soon. Bootstraps and all that.

Issues are twofold here between reimbursement and bureaucracy. Reimbursement will be highly dependent on state. But the paperwork burden is fairly universal here. Medicare is just easier all around to deal with than most payors. Medicaid can pay similarly in some states, but all of the admin burden eats into your time/reimbursement ratio there.

 

[Sanman]

Issues are twofold here between reimbursement and bureaucracy. Reimbursement will be highly dependent on state. But the paperwork burden is fairly universal here. Medicare is just easier all around to deal with than most payors. Medicaid can pay similarly in some states, but all of the admin burden eats into your time/reimbursement ratio there.

None of the states I have been in reimburse anywhere close to even Medicare. The paperwork is worse and the billing more restrictive, especially for treatment reimbursement. I know that @ClinicalABA does alright on the child side.

IMO, the reason for the lack of federal coverage is the perception difference even though the patients can often be similar.

 

[R. Matey]

OR Medicaid pays pretty well, so I hear.

 

[ClinicalABA]

None of the states I have been in reimburse anywhere close to even Medicare. The paperwork is worse and the billing more restrictive, especially for treatment reimbursement. I know that @ClinicalABA does alright on the child side.

Rates are not great for medicaid testing with children, relative to some commercial insurers and- especially- what you could charge private pay. I make up for that in volume, and am also a "value added" service to my parent agency (which is primarily an ABA provider). My salary is augmented by teaching in an affiliated graduate program. I aim to (and usually succeed) in covering my annual salary plus 25% in billable services, but that involves a lot of testing. Across the entire group of psychologists, there are some years where we barely break even (or don't) and the testing services are subsidized by the other services in the agency (which, granted, could not operate without children diagnosed with ASD, and in some areas of the state we are the only ones doing those diagnostic evals). It would be financially difficult to operate a stand alone toddler testing clinic that primarily saw medicaid clients.

 

[msc545]

Issues are twofold here between reimbursement and bureaucracy. Reimbursement will be highly dependent on state. But the paperwork burden is fairly universal here. Medicare is just easier all around to deal with than most payors. Medicaid can pay similarly in some states, but all of the admin burden eats into your time/reimbursement ratio there.

Medicaid (Called MediCal here in CA) is just laughable relative to going rates. Even worse, the paperwork burden is terrible and I am unwilling to do it myself or to hire anyone to do it for me given the very low reimbursement rate for Psychologists. Lastly, if you happen to get caught up in one of their draconian audits, that alone will make you wish you had never billed them.

The MediCal system is California is designed to accomplish two goals:

1. To discourage patients from trying to use it, and this works fairly well when they discover that their are relatively few providers that will accept it.

2. To discourage providers from accepting it for all of the reasons I have previously mentioned. The system is 95% unusable, and if you do try to use it you will be discouraged immediately by the number of ridiculous hoops you have to jump through just to even get credentialed.

 

[summerbabe]

Medicaid (Called MediCal here in CA) is just laughable relative to going rates. Even worse, the paperwork burden is terrible and I am unwilling to do it myself or to hire anyone to do it for me given the very low reimbursement rate for Psychologists. Lastly, if you happen to get caught up in one of their draconian audits, that alone will make you wish you had never billed them.

The MediCal system is California is designed to accomplish two goals:

1. To discourage patients from trying to use it, and this works fairly well when they discover that their are relatively few providers that will accept it.

2. To discourage providers from accepting it for all of the reasons I have previously mentioned. The system is 95% unusable, and if you do try to use it you will be discouraged immediately by the number of ridiculous hoops you have to jump through just to even get credentialed.

I had MediCal as a child.

It was almost impossible for my mom to find me an asthma specialist when I started to develop major problems but eventually she found one. But it was basically through her begging and their kindness that I was able to get seen.

It was a very nice office in a very well to do part of CA (it smelled rich lol) and I wouldn't be surprised if I was a pro bono patient & they never even billed MediCal.