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Setting Up a Forensic Psychiatry Practice

Setting Up a Forensic Psychiatry Practice

Forensic psychiatry has increasingly become an acknowledged and respected
psychiatric subspecialty. In recent decades, greater numbers of general
psychiatrists have added the practice of forensic psychiatry to their clinical
practice. More than 2,200 psychiatrists are members of the American Academy
of Psychiatry and the Law, and at the present time, approximately 45 forensic
fellowship programs offer specialized training in forensic psychiatry in the United States and Canada (Gold, 2004). Since fellowships in forensic psychiatry are new, and since the current number of
fellowships cannot produce all the psychiatrists needed for forensic
examinations, most psychiatrists add forensic psychiatry to an established
practice rather than completing a fellowship and practicing this subspecialty
on a full-time basis.

However, significant clinical and business distinctions exist between the
practice of clinical and forensic psychiatry that should be recognized when
setting up a forensic psychiatry practice. Unlike in a clinical context, a
doctor-patient relationship is not established in the practice of forensic
psychiatry. In addition, a forensic psychiatrist is employed as an agent of a
lawyer, court or other entity requesting forensic services. Therefore, rather
than producing a treatment examination, an expert examination or consultation
service is rendered, and a fee is generated for that service.

Developing a Business Plan

All new businesses should begin with a business plan. Most psychiatrists
lack skill in developing such plans. A written plan is not required, and many
psychiatrists may choose not to complete such a plan at all. However, a
business plan can be an important tool in assisting forensic psychiatrists to
develop the methodology and metrics necessary to properly construct a business.
This is particularly important for the solo practitioner, who may not have the
benefit of the checks and balances present in group practices. The development
of a business plan requires a business model, even if that model is cognitive
rather than written. The psychiatrist is advised to
use an acceptable reference or professional advisors for developing a business
plan (Abrams and Kleiner, 2003).

Table 1 describes the four major
components involved in planning any business, including a forensic psychiatry
practice. All businesses should begin with a mission statement, consisting of a few sentences that concisely
describe the forensic psychiatrist's purpose. For instance, this might include:
"The mission of the XYZ Forensic Psychiatry Practice is to provide state-of-the-art
forensic psychiatric analysis of worker's compensation cases claiming
psychological harm." A well-articulated mission statement provides guidance to
all individuals working within the practice.

The vision statement of a forensic
psychiatry practice is also described in a short sentence, if possible-or a few
sentences at most-to describe where the practice is headed, as guided by the
mission statement. In our current model, it might state, "The XYZ Forensic
Psychiatry Practice will be recognized as this state's leading provider of
worker's compensation injury forensic psychiatric assessments."

Core values describe the ethics
and values of the practice (the business culture) that will be used by the
psychiatrist to guide the mission and vision of the forensic psychiatry
practice. Again, this should be a succinct statement, such as: "The XYZ
Forensic Psychiatry Practice will at all times embody the core values of
honesty and objectivity when providing forensic psychiatric examinations.
Examinations will be completed with integrity, compassion and excellence."

The strategic portion of planning the forensic psychiatric practice
describes the strategies for how the practice's mission and vision will be completed. Strategy is the what of the process, while tactics are the how of the process.

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