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.