How To Start a Telepsychiatry Private Practice (For The Not-So-Business-Savvy Psychiatrist)

The foolproof starter guide to building your telepsychiatry practice without wasting time, energy, and money on the things that don’t matter. This article lays out the step-by-step legal requirements, software systems, and marketing strategies that any psychiatrist or psych NP can follow to launch their dream telepsychiatry practice right now. Let’s get into it! 

If you’re reading this article I assume you landed here because you’re burned out and ready to get the *hell* out of whatever traditional psychiatry setting you work in. Congrats on taking the first step and making a plan to transition into private practice! 

I started my integrative psychiatry private practice, Zen Psychiatry, in 2017 and fell in love with the process of building a business and all things entrepreneurship. Having the freedom to practice the way I want to, seeing the type of patients I want to see, and having the autonomy to structure my work life are great perks too ;-). Owning a private practice makes it easy to love what I do every single day. 

I transitioned my practice entirely to telehealth in October 2019 when my Acute Lymphoblastic T Cell Lymphoma relapsed, so you could say I was a pro at quarantining and seeing patients over video before everyone else did! COVID completely changed the trajectory of how we offer psychiatric care to patients and I don’t see the telepsychiatry model going anywhere anytime soon. Actually, I would say 95% of my patients actually prefer using telehealth because of the convenience of being able to see me in their own home and without a commute. As a physician, telepsychiatry has not interfered with any new or existing patient relationships, nor inhibited me from doing my job (I’ve found even more advanced treatment approaches like prolonged exposure therapy have been doable via video).  

Back to the business of it, unfortunately we don’t learn much (if anything) about how to start a private practice in residency or medical school. I’ve spent the last 4+ years building, testing, and iterating things in my practice until I found what worked. Now that my practice is full, I’ve shifted gears a bit to mentor early career psychiatrists and share more of the valuable lessons and insights I’ve gained along the way.

The goal of this article is to offer you the most efficient plan to set up your telepsychiatry practice and get your first patient – and that means making money with the lowest amount of overhead expenses possible. And yes, your time counts as overhead, so read on for a zero-fluff telepsychiatry business plan to get you on your way. 

1. Adapt the “Just-In-Time” Mindset

If you take one thing away from this article I want it to be this: start your practice lean, mean, and scrappy. Otherwise known as a Just-In-Time mindset.  

The just-in-time mindset was developed by author Eric Reiss in his book The Lean Startup. The book was originally written for tech entrepreneurs but many of the principles carry over to private practice too. 

The idea is don’t try to be perfect out of the gate when you are starting a business (and a private practice IS a business), because you will be wasting your time optimizing for the wrong things. Instead, start lean, mean and scrappy and then build what you need after once you have a few patients and have a sense for what systems you need to run everything efficiently. A lot of physicians are too perfectionistic (which is good for medicine, but bad for business). If you learn how to take your “physician hat” off while setting up your business systems you will be more successful.

If your mind automatically jumps to creating a logo, building a website, hiring an accountant, setting up a corporation, learning every approach to CBT for OCD…stop right there. You don’t need any of these things right now, and it’s only enabling an avoidance strategy to actually start. Just take it from Oprah… 

Perfectionism is the enemy. Be extremely conscientious in your clinical care, but allow for a certain amount of chaos within your business. When I got my first patient back in 2017, I didn’t yet have a way to bill that patient, an EHR to write their note in, or even a chair for them to sit in (I got all that figured out the weekend before our initial appointment!). If there’s a little bit of chaos, you’re doing it right. Why? Because if you focus too soon on the wrong things, you won’t have time to focus on the RIGHT things, which is your marketing strategy for getting patients in the door.

2. Build Your Telepsychiatry MVP Legal and Software Structure for

The term MVP stands for minimum viable product, and in our case, it’s the minimum required structure needed to see your first patient. Legal and software services aren’t the most exciting thing about private practice but the basics are essential and required. The items below are what to take action on right now so that you can start seeing patients. 

Legal Checklist For a Telepsychiatry Practice

1. NPI

If you’re reading this I guarantee you already have an NPI from residency or other clinical training. So you’re off to a good start, check!

2. DEA License

First, you’ll need to register your DEA to the physical location where you’re working. Assuming you are offering telepsychiatry from your home, you would register your home address to your DEA. However, for privacy reasons, you can register your home address as your primary location and a different address for any public-facing documentation. For example, my home address is registered on my DEA but the public-facing address is actually a PO Box. Pro tip: you can work with USPS to convert a PO Box address to a street address with a suite number (Eg, Main Street #1234 instead of PO Box 45). 

You can find more information about registering for a telepsychiatry DEA license here.

Second, if you are planning to see and prescribe to patients in other states via telepsychiatry you will need a DEA license in those states. I am only licensed in California, however there are several practitioners in my program who are licensed in multiple states and have offered a lot of guidance on how to set this up without being physically located in multiple states. One way to do this is to obtain a virtual address with companies like Regis Corporation where you don’t have a physical space, just an address. A few providers in the group will travel to see patients in other states and temporarily rent an office at a shared workspace like a WeWork, and use that address for their DEA. You can also always contact your local state for their opinion as a lot of legislation varies state-by-state. 

Note, you don’t need to be licensed in multiple states to get patients, and I actually don’t recommend going out of your way to get multiple licenses. Trust me, there are more than enough patients in one city, let alone one state, to fill a practice! 

3. Malpractice Insurance

Malpractice insurance is something I highly recommend not being price sensitive to, but instead choose based on the value and experience they can offer to support you in your practice. 

I use MIEC for malpractice insurance and really like them. I’ve never had to file a claim before but whenever I have a question or need advice on something like how to discharge a patient or how to get rid of an after-hours number, they have been extremely helpful and responsive. They are a little pricer than some of their competitors like The Doctors Company and PMRS, but they offer discounted pricing for early-career psychiatrists. 

4. A Way To Collect Payment

The only way you should be collecting payment is via credit card. I repeat, only accept credit cards! There are so many benefits to using a credit card processor to accept payment, like automated billing, ensuring a collection rate of 100%, ease of managing your revenue numbers, adn saving you hours of admin time.  

Stripe, Square, and PracticeQ are three great options with processing fees under 3% and integrate with most EHR systems (more on this below). Do not get caught up in thinking a 3% transaction fee is too much to pay when you can be saving HOURS of time having this set up as an automated process (as well as greatly reduce the likelihood that a patient won’t end up paying you).

Ryan Haight Status As of 2022

The Ryan Haight Act is frequently brought up during my Q&A mentorship calls, so I’m guessing you probably have a few questions about this too.

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (RHA) requires that any practitioner issuing a prescription for a controlled substance conduct an in-person medical evaluation. However, during Public Health Emergencies (PHE) – which as of June 2022 we are still classified under – the Act is temporarily exempt. 

The COVID-19 Public Health Emergency went into effect in January 2020 and placed a temporary hold on the Ryan Haight Act to provide accessibility to healthcare during the pandemic. Over the last 2 years there have been several extensions with the latest update extending through mid-July. However, according to the Department of Health & Human Services department federal officials have pledged to provide a 60-day notice to healthcare providers before the Act is reinstated. At this moment there have not been any new announcements made so I anticipate another PHE extension will be made through at least mid-October.

Personally, I have not been spending my time creating an action plan or worrying about what this will look like in the future. At the end of the day pharmacies are not going to stop filling your prescriptions overnight, and the DEA isn’t going to raid your home office the day after the Act is reinstated. 

Reinstating the Act under its current literature would limit accessibility for many patients and be a major step backwards for healthcare. I anticipate a lot of pushback from both patients and providers, and potential new policy for how telehealth and prescribing controlled substances is regulated in a post-pandemic world. I ultimately wouldn’t let this stop you from starting your telepsychiatry practice right now. Once more finite plans are announced there will literally be millions of healthcare providers who are in your same shoes. And when that time comes, we’ll all be figuring it out together. 

You can find more information on the Ryan Haight Act and exemptions here. You can also contact your malpractice insurance for more details specific to your state. 

Best Softwares For a Telepsychiatry Practice

Don’t make the mistake of being penny wise and pound foolish when it comes to investing in software. I’ve spent a LOT of time researching and testing different softwares in my practice to help streamline and automate processes that were taking too much of my time. The idea is that if you need to spend an extra $50-100 on a software that is going to save you at least an hour of time, it’s probably worth it. As a private practice psychiatrist you’re likely charging hundreds of dollars an hour, so when you do the math $50 is equivalent to at least 10 minutes of your time, if not much more 

Below are the software solutions I recommend currently (as of June 2022) for telepsychiatry psychiatry private practices. 

Practice Management and EHR: IntakeQ/PracticeQ

By far the best software I’m going to recommend is IntakeQ. It is extremely user friendly, efficient to use, and basically includes every aspect of practice management (outside of eprescribe) that you need. 

You can use IntakeQ for charting, scheduling, intake forms, billing (easy to set up auto billing via credit card that is integrated with scheduling – merchant account via Square or Stripe integration), superbills, and telehealth (integrates with Doxy). 

When I started, I looked into a BUNCH of different options for charting/EHR and settled on Luminello for charting and eprescribe. At the time, I think it was the best option and I still use it now. However, Luminello seemed overly clunky to me for intake forms, scheduling and billing. IntakeQ blew any other software out of the water (also really useful for gathering credit card authorizations for billing, having patients submit rating scales, etc). 

HOWEVER, many of the early career psychiatrists in my mentorship program have said that the practice management software now available from IntakeQ (branded now as PracticeQ) is even better than Luminello, including for charting patients notes, which is a new feature they added since I started. I have moved my scheduling and billing over to IntakeQ and continue to use Luminello for charting and eprescribe, but for people who are starting their practices now I recommend using IntakeQ/PracticeQ right out of the gate. They also recently announced that they’ll be launching eprescribe sometime between July-September 2022.  

Eprescribe: iPrescribe (or similar)

Lab ordering: set up an account directly with Quest or LabCorp to order labs electronically. In the meantime, giving the patient a lab order written on a prescription pad (scan and email if needed) works in a pinch when you are first starting your practice. FYI – getting in touch with Quest and LabCorp can be kind of a hassle so don’t be surprised if it takes some time to hear back.

Phone: Google voice is fine, phone.com or RingCentral good if you want extra features like phone tree or have multiple phone numbers (ie you have an assistant or something like that).

Email: Google Workspace, easy to use and it’s HIPAA compliant.  

eFax: SR Fax (integrates with IntakeQ) – unfortunately even though we live in the 21st century pharmacies will still fax you as if it were 1980 so you will need a fax number.

Telehealth Platform: Doxy – I’ve been in practice for 4 years and still use the free version, but if I need to do anything advanced like screenshare lab results with patients, I’ll just pay $10 for a day pass. That has been more cost effective for me rather than paying for a subscription. 

3. Identify How You’re Different & Market Yourself

Before you even THINK about marketing you need to first understand what differentiates you from other psychiatrists that would make a patient choose you as opposed to someone else.

So many psychiatrists avoid this step. But if you don’t spend the time to clearly identify who you help, what value you offer, and the way in which you help them, it will deter you from attracting your dream patients. 

Why? Because you’ll essentially become a commodity (although a highly trained one), which means that patients will see you as interchangeable with any other psychiatrist and will therefore shop based on who is cheapest/has the worst boundaries/will just prescribe them Xanax or whatever. 

One of the first things I help mentees with in my career mentorship program is identifying and articulating their differentiating factors for their bios, Psychology Today profiles, and website copy before they start marketing. The more you communicate what makes you unique on your website or when communicating with patients, the more the “right” kind of patients for you will self-select into your practice. Just take a look at the My Practice page – you KNOW right away what I do, who I help, and what I’m about. 

This isn’t just limited to your clinical experience and background. Think about how your personal experiences have influenced the type of patients you enjoy working with and how you treat them. How would your patients describe you? How would your friends and family describe you? What’s your favorite thing about working with your dream patients? 

PsychologyToday

PsychologyToday is one of the best tools you have at your disposal to start building your patient panel right away. PT is a massive database that gets 40 million visits a month, and is essentially a search engine just for therapists and psychiatrists. This is where your dream patients are looking for you.

However, almost all Psychology Today profiles I see are mediocre at best, which means all you have to do is have an above average profile and you will get all of the Psychology Today traffic in your area. Think about it from a patient’s perspective and what they would look for in a psychiatrist as opposed to trying to impress other psychiatrists in your profile. 

When a patient searches for a psychiatrist in their area, Psychology Today will return a list of providers that they will scroll through. They’ll see your picture, name, where you’re located, phone number, and the first 40 words of your bio – you need to optimize this space and draw their attention.

Don’t use jargon, speak the language the patient speaks, have a clear and professional photo, and don’t be vague. Say what’s unique about you that would make a patient want to see you as opposed to someone else. 

Don’t do this:

Instead, do this:

I highly recommend adding a video alongside your headshot. Even if your video doesn’t really say anything other than “Hi, I’m Dr. so and so, welcome to my practice.” Patients want to see your picture, hear your voice, read a little about who you are, and then contact you. Plus, it seems that bios that include a video seem to rank above others that do not. 

Building Referral Relationships

You already know the obvious stuff like reach out to therapists and other psychiatrists. You can think a lot bigger than this — who is your ideal patient, and where do they hang out? Do they go to certain online forums, see other non-MD providers, purchase other wellness services? You can network with anyone whose niche overlaps with yours who isn’t a direct competitor. Think of providers like, 

• Functional medicine doctors
• Nutritionists
• Acupuncturists
• Women’s Health Physicians

If you already have patients on your panel, consider coordinating care with their other providers and building relationships with them too. Networking is a numbers game – don’t just reach out to 5 people and give up because nothing has happened. 

Don’t Give Up Too Soon

The obstacle is getting comfortable with being uncomfortable. Private practice success doesn’t happen overnight. In fact, I highly encourage my mentees to keep some sort of part time locum or moonlighting job to help pay the bills as you build up your private practice patient panel. 

If you can be consistent and methodical without getting discouraged or giving up too soon you will be successful. Remember: lean, mean, and scrappy! We learn by doing, so don’t be afraid to try new things in the beginning then cut out what doesn’t work. 

And last thing… If you couldn’t tell, I’m kind of obsessed with talking about business and love sharing it with others who are starting their own telepsychiatry private practices too. I’ve been working since last summer with a group of psychiatrists and psych NPs teaching integrative psychiatry protocols and business best practices for private practice success. 

We now have over 140 members in the group and I’m getting messages from them daily about how they’re filling their practices and loving their work! The most recent message was from a psychiatrist who just filled her cash-based telepsychiatry practice in Iowa and Wisconsin… so don’t listen to people telling you this kind of practice is limited to major cities like New York or Los Angeles only. If you want more information about the program, you can access my free webinar training How To Build Your Dream Psychiatry Practice here. 

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