It’s Still Possible-Even in a Managed Care World

June 3, 2011
James S. Goodman, MD
Volume 28, Issue 5

It is still possible for a psychiatrist to have a successful and very gratifying practice that provides psychotherapy (along with medication to those who need both)-even “in a managed care environment.”

In “Talk Doesn’t Pay, So Psychiatry Turns to Drug Therapy,”1The New York Times chronicled Dr Donald Levin’s change from a psychotherapy practice to a very different kind of practice in which he sees 4 follow-up patients an hour-and makes more money. The story is, unfortunately, both sad and true.

My practice is similar to that of Dr Lance, the “former colleague of Dr Levin [who] practices the old style of psychiatry from an office next to her house”1-except that my office is not next to my house and I participate in a few insurance networks. In fact, a substantial portion of my patients see me “in network.” My patients range from business owners and highly accomplished professionals to individuals who struggle to get by on paltry disability payments.

Here in Albuquerque, where there are well over 100 psychiatrists, my wife, Mary L. De Luca, MD, and I are among just a handful who do not take on patients only for “med checks.” As the Times reporter correctly states, we would earn more money if we practiced like Dr Levin. However, the far greater disparity in fees is between those allowed for talking and listening to patients (and even for examining them) and those allowed for procedures. This is true whether it is a psychotherapist-psychiatrist, med-check psychiatrist, or primary care physician who is doing the talking, listening, or examining. I estimate that colleagues who put a rubber band on a hemorrhoid or perform a colonoscopy (both truly valuable services) are allowed fees that amount to 3 to 7 times what I am paid per hour, even after figuring in much higher overhead for such medical procedures.

The good news is that while our numbers are dwindling, it is still possible for a psychiatrist to have a successful and very gratifying practice that provides psychotherapy (along with medication to those who need both)-even “in a managed care environment.” Many patients prefer to see a single clinician, with whom they develop a close relationship, for both psychotherapy and pharmacotherapy. And I believe that in many cases, knowing patients’ psyches more intimately and having more time to inquire into their symptoms and history lead to better recommendations regarding medication.

References:

Reference

1. Harris G. Talk doesn’t pay, so psychiatry turns instead to drug therapy. New York Times. March 5, 2011. http://www.nytimes.com/2011/03/06/health/policy/06doctors.html. Accessed April 1, 2011.