Sunday, April 20, 2008

Getting Started

I'm now accepting new patients for my outpatient psychopharmacology practice. The service I offer is primarily the prescription of psychoactive medications, though I do have extensive training in various forms of psychotherapy, and I am certainly willing to use those skills. Let me state from the beginning that though I plan to practice psychopharmacology primarily, this is not meant to imply that other treament modalities are not important. Rather, psychopharm is simply the hardest part to find, and on the market level, this is what most people are looking for (ie most already have a non-MD therapist of some kind, but need someone with training in my medical specialty to prescribe meds.)

The developmental disorders population is certainly the most underserved of all, with very few practitioners specializing in this kind of treatment. It is my fondest hope that I can build a practice primarily with patients with fragile X, autism spectrum disorders, and other developmental disorders; I've never specialized as a child psychiatrist, but I've always treated lots of kids in previous incarnations of my outpatient practice. Patients of all ages will be welcome in this practice, and I like to think that my experience in treating kids, adults, and geriatric patients will help me to provide better care across the entire age spectrum (something which is usually ignored, even in the few groups which do treat developmental disorders-DDs.) Traditionally, DDs are the subspecialty of some child psychiatrists, but few of them continue treating their patients into adulthood. In the past, this was usually because the kids ended up in institutions of one kind or another, so a state hospital psychiatrist would take over---with mixed results, as you might imagine.

Unfortunately, to build a practice like this on a part-time basis, it isn't feasible to work through insurance companies. Their policies are always restrictive, and the red tape is all-consuming; furthermore, since I aniticipate serving a clientele from a wide area, it will not be possible to accept all the different insurance plans. There are many other issues with insurance and managed care companies (ie they don't pay reasonable rates, then they don't even pay the bills they're supposed to pay) which led to my closing my previous outpatient practice. Therefore, I've made the decision to start out with a simple policy: this is old-school private practice---no insurance, cash only. Needless to say this isn't for everyone, but I will say that psychiatry is pretty cheap by today's medical standards, and the pychiatrist is the cheapest part of psychiatric treatment. Getting state-of-the-art psychopharm treatment costs a lot less than getting your car fixed or your house painted, and we don't think of using insurance for those things. And if you compare the hourly rates and total costs of psychiatric treatment with even the simplest legal services, we're a much better deal. But doctors don't go into medicine for the money (really!) so we always feel guilty about actually charging actual people actual money for our services. Well, I've gotten past that guilt, and it's the only way I can do this kind of practice. So, my apologies in advance, but no insurance, no discounts, cash only (actually, PayPal only, but more on that later.)