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Adding Ancillaries: Counseling services


If you have patients struggling with mental disorders, consider bringing onboard a mental health professional.

Many patients who seek your help with physical ills also struggle with mental disorders, including depression or anxiety. If you don't have the time or expertise to counsel them, consider bringing a mental health professional on board to lend a hand.

Doing so can produce modest financial gains, often at little or no cost. And physicians who've made this move often cite less tangible but equally valuable benefits-including happier patients.

"When patients come here instead of to a psychologist's office, the stigma of going to see a counselor is gone," says Celestino Vega, an FP in Haines City, FL. "I also get a different perspective when a counselor tells me, 'Here's why the patient feels the way he does.' Over the long haul, I think having a counselor helps reduce unnecessary visits for physical ailments that may have a psychological component."

Adding a psychologist isn't the only possibility, especially if patients will be charged on a fee-for-service basis. Other options could include a clinical social worker, an advanced practice registered nurse (APRN), or a licensed professional counselor (LPC). FP Debbie Heck of Muncie, IN, even brought a chaplain into her solo practice for two afternoons a week. Although it didn't add revenue directly, she was able to spend the time she'd have spent dealing with nonmedical questions seeing five to eight more patients.

Here's what you need to know if you want to add mental health counseling to your practice.


You'll need a desk and chair for the counselor, and a love seat or comfortable chair for the patient. Table or desk lamps can provide soft lighting, and inexpensive prints, an end table, knickknacks, or other homey touches can help create a relaxing atmosphere that may encourage patients to talk more openly. A box of Kleenex is also a good idea.


A room as small as 10-feet square will do. However, make sure it's clearly extra space and that you're not sacrificing clinical space, which you can use more profitably seeing patients for other services. If you're short on space but have a comfortably furnished private office, the counselor could use that on your days off, says Indianapolis practice management consultant Michael Brown.

You won't need a separate waiting room, since patients aren't likely to know whether others are there to see you or the counselor. In fact, patients who've come for mental health services may feel self-conscious if they're separated out, says internist Nancy Russell.


You'll either need to hire a mental health practitioner as an employee or bring one on as an independent contractor.

The counselor probably won't see more than half a dozen or so patients per day, so your existing staff should be able to absorb the additional scheduling and billing work. And if the counselor comes aboard as an independent contractor, she may be willing to handle her own scheduling and billing if your staff is overextended.


Equipment costs for this service are minimal, unless you spring for a deluxe couch, lounge chairs, and other high-end furnishings.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health