Delaying Sessions

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Michealrack, I am not going to debate philosophy on here but I guess I was speaking from a moral stance. Low quality healthcare service delivery is not something that I would consider an option to practice..

well perhaps part of this is because you don't have the option to do so.....or at least the type of low quality care several people in this thread have endorsed/admitted to practicing.

Given the option of doing something you know you can do fairly easily for 180-200k/year+ benefits and decent hours(quick med checks) and not have to think too hard or get extra training vs........making much much less(at least initially), working harder(mentally and in terms of hours preparing), and having more day to day struggles.....well is it any wonder our field is where it is?

And as I said earlier, I don't blame people for doing this. But as I said before, let's call it what it is....

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terrible analogy because the therapy *is* the hard part. In most cases, psychopharm(even when done fairly well) just isn't very difficult.

You couldn't have said it any better!
 
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well perhaps part of this is because you don't have the option to do so.....or at least the type of low quality care several people in this thread have endorsed/admitted to practicing.

Vistaril, it doesn't matter whther I have the option. All those people have an option NOT to. I think thats really the only salient point here.

And, obvioulsy steak wasnt the best analogy, but my point is quite obvious, no? There is consistent feedback about the product. No attempt is being made to alter the product. Businesses that care about their customer base beyond earning potential make changes in order to serve those customers. Its pretty basic and pretty universal. My barber does it, my local dry cleaner does it, so does my kids pediatrician. Why doesn't it happen here? I dont really know.
 
I think its worth mentioning part of the context of 15 minute meds checks being considered acceptable practice by many is related to psychiatry being under the umbrella of medicine as a whole. 15 minutes of face to face time with a physician would be considered a very, very generous appointment length in many fields of medicine. Thats not to say its necessarily the best practice, but when the face to face time for a follow up visit in a lot of specialties is probably closer to 5-8 minutes, its easy to see how the medical community isn't up in arms about 15 minute medchecks.
 
Vistaril, it doesn't matter whther I have the option. All those people have an option NOT to. I think thats really the only salient point here.

And, obvioulsy steak wasnt the best analogy, but my point is quite obvious, no? There is consistent feedback about the product. No attempt is being made to alter the product. Businesses that care about their customer base beyond earning potential make changes in order to serve those customers. Its pretty basic and pretty universal. My barber does it, my local dry cleaner does it, so does my kids pediatrician. Why doesn't it happen here? I dont really know.

sure you know why.....because the customer in this case is really the third party payer. In a cash pay model, you would be right and that's why psychs *do* alter the product there to cater to patient needs/demands.

but the people in this thread doing quick med checks(and mostly in the community at large) are not working in a cash system, but a third party payer system.

You also used a key phrase....beyond earning potential. Many people don't care about anything beyond this(and their lifestyle/hassle/workload.....which also favors med checks)
 
it's good to see vistaril and erg arguing in one thread on the forum and leaving the rest alone. keep 'em busy as they say
 
I think its worth mentioning part of the context of 15 minute meds checks being considered acceptable practice by many is related to psychiatry being under the umbrella of medicine as a whole. 15 minutes of face to face time with a physician would be considered a very, very generous appointment length in many fields of medicine. Thats not to say its necessarily the best practice, but when the face to face time for a follow up visit in a lot of specialties is probably closer to 5-8 minutes, its easy to see how the medical community isn't up in arms about 15 minute medchecks.

it's very rare for a 15 minute med check slot to actually contain anywhere near 15 minutes of face time. And if it does, then the next patient is getting much much less. Scheduling 4 pts/hr results in less than 10 minutes on average of 'clinical' face time, and that's even if you have things streamlined(ie you don't take bathroom or coffee breaks very often, there is a very fast transition into the office, etc)
 
it's very rare for a 15 minute med check slot to actually contain anywhere near 15 minutes of face time. And if it does, then the next patient is getting much much less. Scheduling 4 pts/hr results in less than 10 minutes on average of 'clinical' face time, and that's even if you have things streamlined(ie you don't take bathroom or coffee breaks very often, there is a very fast transition into the office, etc)

A lot of my visits end up going over the 15 minute slot. Some have gone to 25 minutes and I end up staying later.
 
A lot of my visits end up going over the 15 minute slot. Some have gone to 25 minutes and I end up staying later.

how are you scheduling patients though? If you schedule 4/hr and an early patient goes over, then you have to either give another patient much less than 15 minutes or run behind on all patients and have all patients wait.

In reality I think a lot of psychs who grind out quick med mgt visits whole days at a time are playing a constant game of catching up, falling behind, catching up, falling behind, etc.....not unlike a family medicine physician.
 
sure you know why.....because the customer in this case is really the third party payer. In a cash pay model, you would be right and that's why psychs *do* alter the product there to cater to patient needs/demands.

Your perception that a “third party” pays for a patient’s health care and is thus the customer, is incorrect. When you buy insurance, you have an agreement that is maintained by your payment of premiums that who you buy insurance from will pay for your service within the agreements it has established with its providers. You signed an agreement with the companies that you will abide by that relationship. The check comes from the insurance company because the patient has insurance with them. The patient is who receives and pays for your care through that broker (i.e. third party). They are disbursing the money from the pool the patient has paid into (a claim). It is not the insurance companies money. So mKs no mistake, these people are still paying you for a service, there is just a middleman involved. Thus, any rationalization a provider makes based on this for provinding a lower quality product/service is invalid, and is really exactly what I just said: A rationalization. I guess that's my dynamic reference for this discussion. :)
 
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well perhaps part of this is because you don't have the option to do so.....or at least the type of low quality care several people in this thread have endorsed/admitted to practicing.

Given the option of doing something you know you can do fairly easily for 180-200k/year+ benefits and decent hours(quick med checks) and not have to think too hard or get extra training vs........making much much less(at least initially), working harder(mentally and in terms of hours preparing), and having more day to day struggles.....well is it any wonder our field is where it is?

And as I said earlier, I don't blame people for doing this. But as I said before, let's call it what it is....


Disagree.

1) Medical school does not teach you anything about therapy. When someone decides they want to do psychiatry, they don't necessarily want to do therapy. I, for one, was fascinated with the disorders and that's why I chose psychiatry. I think it's appropriate for all psychiatrists to practice the common features of psychotherapy (accepting, committed, empathy, engaged listening, etc) in their sessions, but I don't think anyone who doesn't "do" psychotherapy is not doing it because it is hard or they are "taking the easy road". Some psychiatrists just don't like it. Furthermore, not wanting to do say psychodynamic because I don't believe in it's principles or it's efficiency does not mean I don't want to do it because it is hard.

2) "Just managing medications" is more than prescribing x drug for y disorder. There are multiple factors that go into each diagnosis and that needs to be analyzed by each prescriber. "Just managing medications" is how you end up with terrible psychiatrists.

3) Managing medications is easy for you because you have used these medications over a thousand times by now. It's the same for endocrine doc, rheum docs, ID docs, etc etc. However, ask an IM doc or a FM doc how comfortable they feel using anti-psychotics, Lithium, MAOIs, etc and most will tell you they won't use it. What a cardiologist does is easy for a cardiologist to do because he or she is well trained in it. Don't make the mistake of thinking your proficiency in psychiatry makes psychiatry easy to practice. God knows I have seen enough terrible psychiatrists in the community. If it was that easy, I would expect to see a much better standard of care.
 
Your perception that a “third party” pays for a patient’s health care and is thus the customer, is incorrect. When you buy insurance, you have an agreement that is maintained by your payment of premiums that who you buy insurance from will pay for your service within the agreements it has established with its providers. You signed an agreement with the companies that you will abide by that relationship. The check comes from the insurance company because the patient has insurance with them. The patient is who receives and pays for your care through that broker (i.e. third party). They are disbursing the money from the pool the patient has paid into (a claim). It is not the insurance companies money. So mKs no mistake, these people are still paying you for a service, there is just a middleman involved. Thus, any rationalization a provider makes based on this for provinding a lower quality product/service is invalid, and is really exactly what I just said: A rationalization. I guess that's my dynamic reference for this discussion. :)

while this is all true, there are a number of factors that make it such that the third party payer is our real client:

1) Most people don't value their insurance by the mental health coverage it provides. Heck, I would even guess that people who have even used their insurance for outpt mh visits at some point still don't judge their insurance by this. And hey, the proof is in the results.....people aren't cancelling their insurance because they are dissatisfied with their outpt mh care(even though we both know they are)
2) It's not a true open marketplace for most people. Chances are they still get their insurance through their employer, which offers a few different levels of care. Patients aren't going to figure out ahead of time before signing up for a plan what outpt providers are going to provide pt centered care.

so yeah in a theoretical sense the ultimate customer is the person purchasing the insurance, but due to the issues above that's not of great importance.
 
how are you scheduling patients though? If you schedule 4/hr and an early patient goes over, then you have to either give another patient much less than 15 minutes or run behind on all patients and have all patients wait.

In reality I think a lot of psychs who grind out quick med mgt visits whole days at a time are playing a constant game of catching up, falling behind, catching up, falling behind, etc.....not unlike a family medicine physician.

I do schedule 4 visits in an hour, 15 minutes each. I don't always get 4 patients in an hour, even though I work in my private practice only in the afternoons till early evenings. I work inpatient during the day.

It does help when some of my patients are stabilized and want to leave very early, although I think this makes me sound like a factory worker. I notice some of my suboxone patients don't want to stay to long. But, I do go overtime especially with a couple of patients.

Not to go off on a tangent, anyone working with suboxone patients?
 
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Michealrack, I am not going to debate philosophy on here but I guess I was speaking from a moral stance. Low quality healthcare service delivery is not something that I would consider an option to practice.

.

We agree on healthcare but not on steak. Let me try to make my point more clearly: Under certain circumstances, it is possible to make more $ by providing lower quality steaks/healthcare. It is ok to provide low quality steaks, but not low quality healthcare.
 
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